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de Asmundis C, Pannone L, Lakkireddy D, Beaver TM, Brodt CR, Lee RJ, Sorgente A, Gauthey A, Monaco C, Overeinder I, Bala G, Almorad A, Ströker E, Sieira J, Brugada P, Chierchia GB, La Meir M, Olshansky B. Targeted Treatment of Inappropriate Sinoatrial Node Tachycardia Based on Electrophysiological and Structural Mechanisms. Am J Cardiol 2022; 183:24-32. [PMID: 36127177 DOI: 10.1016/j.amjcard.2022.07.041] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 07/06/2022] [Accepted: 07/08/2022] [Indexed: 11/01/2022]
Abstract
The purpose of this review is to determine the causal mechanisms and treatment of inappropriate sinoatrial tachycardia (IST), defined as a non-physiological elevation in resting heart rate. IST is defined as a resting daytime sinus rate >100 beats/minute and an average 24-hour heart rate >90 beats/minute. Potential causal mechanisms include sympathetic receptor hypersensitivity, blunted parasympathetic tone, or enhanced intrinsic automaticity within the sinoatrial node (SAN) pacemaker-conduction complex. These anomalies may coexist in the same patient. Recent ex-vivo near-infrared transmural optical imaging of the SAN in human and animal hearts provides important insights into the functional and molecular features of this complex structure. In particular, it reveals the existence of preferential sinoatrial conduction pathways that ensure robust SAN activation with electrical conduction. The mechanism of IST is debated because even high-resolution electroanatomical mapping approaches cannot reveal intramural conduction in the 3-dimensional SAN complex. It may be secondary to enhanced automaticity, intranodal re-entry, or sinoatrial conduction pathway re-entry. Different pharmacological approaches can target these mechanisms. Long-acting β blockers in IST can act on both primarily increased automaticity and dysregulated autonomic system. Ivabradine targets sources of increased SAN automaticity. Conventional or hybrid ablation may target all the described abnormalities. This review provides a state-of-the-art overview of putative IST mechanisms. In conclusion, based on current knowledge, pharmacological and ablation approaches for IST, including the novel hybrid SAN sparing ablation, are discussed.
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Affiliation(s)
- Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium.
| | - Luigi Pannone
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | | | - Thomas M Beaver
- Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, Florida
| | | | - Randall J Lee
- Section of Cardiology, University of California at San Francisco, San Francisco, California
| | - Antonio Sorgente
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Anaïs Gauthey
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Cinzia Monaco
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Ingrid Overeinder
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Gezim Bala
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Alexandre Almorad
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Erwin Ströker
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Juan Sieira
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Pedro Brugada
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Mark La Meir
- Cardiac Surgery Department, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, Brussels, Belgium
| | - Brian Olshansky
- Division of Cardiology, University of Iowa Hospitals, Iowa City, Iowa
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Cheng W, Liu J, Zhi M, Shen D, Shao M, Zhang C, Wang G, Jiang Z. Stress and autonomic nerve dysfunction monitoring in perioperative gastric cancer patients using a smart device. Ann Noninvasive Electrocardiol 2021; 27:e12903. [PMID: 34669995 PMCID: PMC8739623 DOI: 10.1111/anec.12903] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2021] [Revised: 09/13/2021] [Accepted: 09/13/2021] [Indexed: 12/22/2022] Open
Abstract
Background Heart rate variability (HRV), a sensitive marker of stress and autonomic nervous disorders, was significantly decreased in cardiovascular disease, inflammation, and surgical injury. However, the effect of radical gastrectomy on HRV parameters needs to be further investigated. Methods A prospective, observational study including 45 consecutive enrolled patients undergoing radical gastrectomy in our enhanced recovery after surgery (ERAS) programs was conducted. Frequency‐ and time‐domain parameters of HRV from 1 day prior to operation to 4 days postoperatively were continuously measured. Meanwhile, plasma cortisol and inflammatory markers were recorded and correlated to HRV parameters. Results Heart rate variability showed a solidly circadian rhythm. Anesthesia severely disturbed HRV parameters, resulting in a reduction of most of the HRV parameters. Frequency‐domain parameter (including VLF) and time‐domain parameters (including the SDNN, SDANN, and triangular index) of HRV demonstrated a significant reduction compared to preoperative values on the postoperative day 1 (Pod1), and these HRV parameters could return to baseline on Pod2 or Pod3, indicating surgical stress and autonomic nerve dysfunction existed in the early postoperative period. Inflammatory biomarkers were significantly elevated on Pod1 and Pod3. Plasma cortisol decreased significantly on Pod1 and Pod3. Both inflammatory biomarkers and plasma cortisol had no significant correlation with HRV parameters. Conclusions Compared with plasma cortisol and inflammation biomarkers, HRV is more sensitive to detect surgical stress and autonomic nervous dysfunction induced by radical gastrectomy in patients with gastric cancer.
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Affiliation(s)
- Wei Cheng
- Department of General Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Jiang Liu
- Department of General Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Mengwei Zhi
- School of Nursing, Nanjing University of Chinese Medicine, Nanjing, China
| | - Danli Shen
- Department of General Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Mingyue Shao
- Department of General Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Cheng Zhang
- Department of General Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Gang Wang
- Department of General Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
| | - Zhiwei Jiang
- Department of General Surgery, Jiangsu Province Hospital of Chinese Medicine, Affiliated Hospital of Nanjing University of Chinese Medicine, Nanjing, China
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Cardiology meets neurology: clinical presentation and management of patients with primary neurogenic disorders and orthostatic intolerance. Herzschrittmacherther Elektrophysiol 2021; 32:335-340. [PMID: 34251502 DOI: 10.1007/s00399-021-00779-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Accepted: 06/01/2021] [Indexed: 10/20/2022]
Abstract
Patients with primary neurogenic disorders such as pure autonomic failure or multiple system atrophy may initially present with cardiocirculatory symptoms such as orthostatic intolerance or fluctuations in heart rate with symptomatic tachycardia. It is therefore clinically important to identify such patients since circulatory manifestations are only one of a series of symptoms resulting from autonomic dysfunction in various organ systems. These patients require a multimodal diagnostic and therapeutic approach and should undergo extensive evaluation in a specialized autonomic nervous system (ANS) outpatient unit. Based on a clinical case presentation, the current review summarizes the diagnostic and therapeutic approach to key cardiovascular symptoms of primary autonomic disorders and their neurological work-up in a specialized autonomic function laboratory.
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Kaczmarek K, Klingenheben T, Poddebska I, Urbanek I, Wranicz JK, Cygankiewicz I, Ptaszyński P. Baseline intrinsic heart rate and response to ivabradine treatment in patients with inappropriate sinus tachycardia. Ann Noninvasive Electrocardiol 2019; 25:e12709. [PMID: 31595620 PMCID: PMC7358846 DOI: 10.1111/anec.12709] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2019] [Accepted: 09/14/2019] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Treatment with ivabradine became a new therapeutic alternative for patients with inappropriate sinus tachycardia (IST). The aim was to determine a relation between intrinsic heart rate (IHR) and response to ivabradine treatment. METHODS Twenty-seven patients (mean age 37 ± 11; 23 women) with symptomatic IST despite medical treatment were recruited into the study. Resting ECG, 24-hr ECG monitoring (24hECG), exercise treadmill test, and symptoms evaluation were performed initially and after 60 days on ivabradine. IHR was acquired at baseline after pharmacological autonomic blockade. RESULTS Nineteen patients (70%) were classified as abnormal IHR group (AIHR) while eight showed normal IHR (NIHR). No significant differences in ECG parameters were found between NIHR and AIHR subgroups, while baseline exercise capacity was higher in AIHR patients (10.9 vs. 9.5 METs, p < .05). Ivabradine treatment resulted in significant reduction in resting heart rate, average 24hECG heart rate, improvement in exercise capacity and reduction of symptoms in both subgroups. Nevertheless, favorable influence of ivabradine was significantly more exaggerated in AIHR subgroup (HR 116 vs. 90 bpm, av. HR 98 vs. 79 bpm, 10.9 vs. 13.6 METS, EHRA score 3.1 vs. 1.1, p < .001 for all) than in NIHR patients (HR 112 vs. 98 bpm, av. HR 97 vs. 88 bpm, 9.5 vs. 11.1 METs, EHRA score 3.1 vs. 1.9; p < .05 for all). CONCLUSIONS Intrinsic heart rate may be useful in predicting response to ivabradine in patients with IST. More intense response to ivabradine in patients with AIHR may be attributed to different pathophysiological mechanisms underlying IST in AIHR and NIHR groups.
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Affiliation(s)
| | | | - Izabela Poddebska
- Department of Electrocardiology, Medical University of Lodz, Lodz, Poland
| | - Irmina Urbanek
- Department of Electrocardiology, Medical University of Lodz, Lodz, Poland
| | - Jerzy K Wranicz
- Department of Electrocardiology, Medical University of Lodz, Lodz, Poland
| | - Iwona Cygankiewicz
- Department of Electrocardiology, Medical University of Lodz, Lodz, Poland
| | - Pawel Ptaszyński
- Department of Electrocardiology, Medical University of Lodz, Lodz, Poland
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Kosiuk J, Portugal G, Hilbert S, John S, Oliveira M, Hindricks G, Bollmann A. In vivo
validation of a novel algorithm for automatic premature ventricular contractions recognition. J Cardiovasc Electrophysiol 2017; 28:828-833. [DOI: 10.1111/jce.13224] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 03/11/2017] [Accepted: 03/26/2017] [Indexed: 11/29/2022]
Affiliation(s)
- Jedrzej Kosiuk
- Department of Electrophysiology; Heart Center Leipzig; Leipzig Germany
| | - Guilherme Portugal
- Department of Cardiology, Hospital de Santa Marta; Centro Hospitalar Lisboa Centtral; Lisbon Portugal
| | - Sebastian Hilbert
- Department of Electrophysiology; Heart Center Leipzig; Leipzig Germany
| | - Silke John
- Department of Electrophysiology; Heart Center Leipzig; Leipzig Germany
| | - Mario Oliveira
- Department of Cardiology, Hospital de Santa Marta; Centro Hospitalar Lisboa Centtral; Lisbon Portugal
| | - Gerhard Hindricks
- Department of Electrophysiology; Heart Center Leipzig; Leipzig Germany
| | - Andreas Bollmann
- Department of Electrophysiology; Heart Center Leipzig; Leipzig Germany
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Abstract
Substantial differences in the risk of common arrhythmia syndromes exist between men and women, as well as in varying ethnic/racial groups. For example, despite an overall lower risk of sudden death and atrial fibrillation in women compared with men, women have longer QT intervals and a higher risk of torsades de pointes due to antiarrhythmic drugs and worse outcomes associated with atrial fibrillation. An ethnicity-related paradox in atrial fibrillation epidemiology is apparent; despite a higher prevalence of medical comorbidities such as hypertension, diabetes, and prolonged PR interval, blacks, Hispanics, and Asians have a lower risk of atrial fibrillation than whites. In this promising era of genomic medicine, an improved understanding of epidemiology and phenotype holds the potential for revealing novel therapeutic targets and preventing disease.
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Affiliation(s)
- Santosh Rane
- Department of Medicine, Division of Cardiology, University of Washington, 1959 NE Pacific Street, Box 356422, Seattle, WA, 98122, USA
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Diurnal variation in the diving bradycardia response in young men. Clin Auton Res 2016; 26:135-40. [PMID: 26795189 DOI: 10.1007/s10286-016-0342-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 01/06/2016] [Indexed: 10/22/2022]
Abstract
PURPOSE The present study aimed to examine diurnal variation of the diving bradycardia responses on the same day. METHODS Eighteen young men (age 26 ± 2 years; height 174.2 ± 6.0 cm; body mass 70.2 ± 8.1 kg; body fat 18.0 ± 3.8 %; mean ± standard deviation) participated in this study. Oral temperature, heart rate variability (HRV) from 5-min of electrocardiogram data, and diving bradycardia responses were measured at 0900, 1300, and 1700 hours daily. All participants performed diving reflex tests twice in the sitting position with the face immersed in cold water (1.9-3.1 °C) and apnea at midinspiration for a minimum of 30 s and as long as possible, in consecutive order. RESULTS Oral temperature was found to be less in the morning (0900) than in the afternoon (1300) and evening (1700). In the frequency domain parameters of heart rate variability, the natural logarithms of high-frequency power were higher in the morning than in the evening. All participants showed bradycardia response to the two diving reflex tests. The peak values of R-R interval during the diving reflex test both for as long as possible and 30 s were longer in the morning than in the afternoon and evening. CONCLUSION Our results indicated that the maximal bradycardia during the diving reflex test exhibits a diurnal variation, with peak levels at morning and gradual decrease towards the evening. The HRV indexes show the same variation.
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ZHOU XIAOYA, ZHOU LIPING, WANG SONGYUN, YU LILEI, WANG ZHUO, HUANG BING, CHEN MINGXIAN, WAN JUN, JIANG HONG. The Use of Noninvasive Vagal Nerve Stimulation to Inhibit Sympathetically Induced Sinus Node Acceleration: A Potential Therapeutic Approach for Inappropriate Sinus Tachycardia. J Cardiovasc Electrophysiol 2015; 27:217-23. [PMID: 26467778 DOI: 10.1111/jce.12859] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2015] [Revised: 09/27/2015] [Accepted: 10/08/2015] [Indexed: 11/27/2022]
Affiliation(s)
- XIAOYA ZHOU
- Department of Cardiology, Renmin Hospital of Wuhan University; Cardiovascular Research Institute of Wuhan University; Wuhan Hubei China
| | - LIPING ZHOU
- Department of Cardiology, Renmin Hospital of Wuhan University; Cardiovascular Research Institute of Wuhan University; Wuhan Hubei China
| | - SONGYUN WANG
- Department of Cardiology, Renmin Hospital of Wuhan University; Cardiovascular Research Institute of Wuhan University; Wuhan Hubei China
| | - LILEI YU
- Department of Cardiology, Renmin Hospital of Wuhan University; Cardiovascular Research Institute of Wuhan University; Wuhan Hubei China
| | - ZHUO WANG
- Department of Cardiology, Renmin Hospital of Wuhan University; Cardiovascular Research Institute of Wuhan University; Wuhan Hubei China
| | - BING HUANG
- Department of Cardiology, Renmin Hospital of Wuhan University; Cardiovascular Research Institute of Wuhan University; Wuhan Hubei China
| | - MINGXIAN CHEN
- Department of Cardiology; the Second Xiangya Hospital of Central South, University; Changsha Hunan China
| | - JUN WAN
- Department of Cardiology, Renmin Hospital of Wuhan University; Cardiovascular Research Institute of Wuhan University; Wuhan Hubei China
| | - HONG JIANG
- Department of Cardiology, Renmin Hospital of Wuhan University; Cardiovascular Research Institute of Wuhan University; Wuhan Hubei China
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9
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Olshansky B, Sullivan RM. Conventional management of inappropriate sinus tachycardia. J Interv Card Electrophysiol 2015; 46:43-5. [DOI: 10.1007/s10840-015-0034-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2015] [Accepted: 06/22/2015] [Indexed: 02/04/2023]
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Differences in cardiac autonomic function contributes to heart rate abnormalities in POTS and IST. Auton Neurosci 2014; 186:85-90. [DOI: 10.1016/j.autneu.2014.09.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2014] [Revised: 09/10/2014] [Accepted: 09/11/2014] [Indexed: 11/15/2022]
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Morino M, Masaki C, Seo Y, Mukai C, Mukaibo T, Kondo Y, Shiiba S, Nakamoto T, Hosokawa R. Non-randomized controlled prospective study on perioperative levels of stress and dysautonomia during dental implant surgery. J Prosthodont Res 2014; 58:177-83. [PMID: 24981241 DOI: 10.1016/j.jpor.2014.03.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2014] [Revised: 03/12/2014] [Accepted: 03/17/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE The purpose of this study was to compare pre- and postoperative autonomic activities and changes in salivary stress biomarkers between patients who received only local anesthesia and those who received local anesthesia together with intravenous sedation in dental implant surgery. METHODS A total of 21 patients were enrolled in this non-randomized controlled prospective study; 7 subjects underwent implant surgery under local anesthesia with intravenous sedation and 14 subjects underwent surgery under only local anesthesia. Stress was evaluated by measuring salivary levels of chromogranin A (CgA) and a spectral analysis of heart rate variability (HRV) at baseline (on a day other than the day of surgery), 1h preoperatively, and 1h postoperatively. HRV analysis yields low- (LF) and high-frequency (HF) components, the LF/HF ratio, and the component coefficient of variance (CCV[HF]), which provide indices of sympathetic and parasympathetic regulatory activity. RESULTS CgA levels were significantly higher (p<0.05) at baseline in patients who received sedation than those who did not, but CgA levels did not differ prior to surgery. Also, the values of most parameters, including LF, HF, LF/HF (L/H), and CCV(HF), did not significantly differ between groups or among the three time points. Only ΔL/H and ΔCCV(HF) were significantly lower (p<0.05) at 1h preoperatively in patients who received sedation than those who received only local anesthesia. CONCLUSIONS CgA levels were high in both groups immediately before surgery, and thus CgA values immediately before surgery may not be a reliable indicator of the need for intravenous sedation. Also, spectral analysis of HRV, especially ΔL/H and ΔCCV(HF), could be useful for assessing tension and anxiety.
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Affiliation(s)
- Miyuki Morino
- Department of Oral Reconstruction and Rehabilitation, Kyushu Dental University, Graduate School, Japan
| | - Chihiro Masaki
- Department of Oral Reconstruction and Rehabilitation, Kyushu Dental University, Graduate School, Japan
| | - Yoshinori Seo
- Department of Oral Reconstruction and Rehabilitation, Kyushu Dental University, Graduate School, Japan
| | - Chisato Mukai
- Department of Oral Reconstruction and Rehabilitation, Kyushu Dental University, Graduate School, Japan
| | - Taro Mukaibo
- Department of Oral Reconstruction and Rehabilitation, Kyushu Dental University, Graduate School, Japan
| | - Yusuke Kondo
- Department of Oral Reconstruction and Rehabilitation, Kyushu Dental University, Graduate School, Japan
| | - Shunji Shiiba
- Department of Dental Anesthesiology, Kyushu Dental University, Japan
| | - Tetsuji Nakamoto
- Department of Oral Reconstruction and Rehabilitation, Kyushu Dental University, Graduate School, Japan
| | - Ryuji Hosokawa
- Department of Oral Reconstruction and Rehabilitation, Kyushu Dental University, Graduate School, Japan.
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Rossi S, Rocchi C, Studer V, Motta C, Lauretti B, Germani G, Macchiarulo G, Marfia GA, Centonze D. The autonomic balance predicts cardiac responses after the first dose of fingolimod. Mult Scler 2014; 21:206-16. [PMID: 24957049 DOI: 10.1177/1352458514538885] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
BACKGROUND Predictive markers of cardiac side effects would be helpful for the stratification and individualized monitoring of multiple sclerosis (MS) patients prescribed with fingolimod. OBJECTIVE To test whether the autonomic balance predicts a cardiac response after the first dose of fingolimod. METHODS A total of 55 consecutive relapsing-remitting MS (RRMS) patients underwent 'head-up tilt', Valsalva maneuver, deep breathing and handgrip tests before their first dose of fingolimod. The normalized unit of the high frequency (HF) component (HF normalized units; HFnu), reflecting mostly vagal activity; and the low frequency (LF) component (LF normalized units; LFnu) reflecting mostly sympathetic activity, were considered for the analysis of heart rate (HR) variability. The patients' HR and electrocardiographic parameters ((the interval between P wave and ventricular depolarization (PR); the interval between Q and T waves (QT)) were recorded during 6-hour post-dose monitoring. RESULTS We found significant correlations between measures of parasympathetic function and fingolimod-induced bradycardia. Subjects with higher Valsalva ratio and HR variation during deep breathing had, in fact, nadir HR ≤ 50 beats/minute (bpm) after the first fingolimod dose. Conversely, significant negative correlations were found between measures of sympathetic function and fingolimod-induced PR interval increase. Subjects with lower LFnu at rest and less increase of blood pressure on the handgrip test showed a PR interval increase > 20 ms after fingolimod. CONCLUSIONS Assessing autonomic control of cardiovascular functions can be useful to predict cardiac effects after the first fingolimod dose.
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Affiliation(s)
- S Rossi
- Clinica Neurologica, Università Tor Vergata, Rome, Italy/Fondazione Santa Lucia, Centro Europeo per la Ricerca sul Cervello (CERC), Rome, Italy
| | - C Rocchi
- Clinica Neurologica, Università Tor Vergata, Rome, Italy
| | - V Studer
- Clinica Neurologica, Università Tor Vergata, Rome, Italy/Fondazione Santa Lucia, Centro Europeo per la Ricerca sul Cervello (CERC), Rome, Italy
| | - C Motta
- Clinica Neurologica, Università Tor Vergata, Rome, Italy/Fondazione Santa Lucia, Centro Europeo per la Ricerca sul Cervello (CERC), Rome, Italy
| | - B Lauretti
- Clinica Neurologica, Università Tor Vergata, Rome, Italy
| | - G Germani
- Clinica Neurologica, Università Tor Vergata, Rome, Italy/Fondazione Santa Lucia, Centro Europeo per la Ricerca sul Cervello (CERC), Rome, Italy
| | - G Macchiarulo
- Clinica Neurologica, Università Tor Vergata, Rome, Italy/Fondazione Santa Lucia, Centro Europeo per la Ricerca sul Cervello (CERC), Rome, Italy
| | - G A Marfia
- Clinica Neurologica, Università Tor Vergata, Rome, Italy
| | - D Centonze
- Clinica Neurologica, Università Tor Vergata, Rome, Italy/Fondazione Santa Lucia, Centro Europeo per la Ricerca sul Cervello (CERC), Rome, Italy
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