| Objective Using heart rate variability (HRV) analysis evaluate the children with atrioventricular conduction block (AVB), and explore the value of HRV analysis to identify organic AVB.Methods 58 children with AVB were divided into two groups according to whether or not organic heart disease—Non-organic heart disease (A group of 28 cases), Organic heart disease (B group of 30 cases). Compared with healthy children (30 cases), and by age 6, those groups divided into the senior and yong groups. Record the 24-hour Holter monitoring, observe the time domain and frequency domain indicators during the total 24-hour and waking and sleeping period.Results1. 24h Holter monitoring:Non-organic heart disease group: 14 cases of I°AVB, 4 cases of I°AVB, 4 cases of I°AVB with Morbiz I°AVB in night, 4 cases of I°AVB associated with sinus bradycardia, 2 cases of I°AVB associated with sinus arrhythmia; All of the cases had circadian rhythm. AVB and heart rate were related, when heart rate reduced, PR interval extended, and when heart rate increased, PR interval shortened, AVB reduced even disappeared.Organic heart disease group: 8 cases of I°AVB, 8 cases of I°AVB with ST changes in tachycardia, 3 cases of I°AVB with Morbiz I°AVB in night and combined premature ventricular contractions, 4 cases of I°AVB associated with sinus tachycardia, 3 cases of I°AVB associated with atrial premature beats, 2 cases of I°AVB associated with sinus arrhythmia, 2 cases of I°AVB associated with sinus node pacemaker migration; Circadian rhythm was obvious in 19 cases. AVB and heart rate were related in 18 cases, in 12 cases showing a negative correlation (when heart rate increased, PR interval shortened, AVB reduced even disappeared), in 6 cases showed a positive correlation (the quicker the heart rate the longer the interval PR), 12 cases had no correlation of heart rate.2. HRV in 24 hours Young group: two groups and compared to the control group, SDNN, RMSSD, LF, HF were significantly different (P <0.05), SDANN, PNN50, VLF, LF/HF were not significantly different; in the Non-organic heart disease and organic heart disease groups, RMSSD and LF were significantly different (P<0.05), SDNN, SDANN, PNN50, VLF, HF, LF/HF was no significant difference. Older group: the two groups and compared to the control group, SDNN, RMSSD, LF, HF were significantly different (P<0.05), SDANN, PNN50, VLF, LF/HF were not significantly different; in the Non-organic heart disease and organic heart disease groups, SDNN, SDANN, RMSSD, PNN50, VLF, LF, HF, LF/HF were not significantly different.3. HRV of Waking period Young groups: two groups and compared to the control group, SDNN, RMSSD, VLF, LF, HF, LF/HF were significantly different (P<0.05), SDANN, PNN50 were no significant difference; In the Non-organic heart disease and organic heart disease groups, SDNN, RMSSD and PNN50 were significantly different (P<0.05), SDANN, VLF, LF, HF, LF/HF were no significant difference. Older groups: the two groups and compared to the control group, SDNN, RMSSD, VLF, LF, HF, LF/HF were significant differences (P<0.05), SDANN, PNN50 had no significant difference; in the Non-organic heart disease and organic heart disease groups, SDNN, SDANN, RMSSD, PNN50, VLF, LF, HF, LF/HF were not significantly different.4. HRV of Sleeping period Young group: two groups and compared to the control group, SDNN, RMSSD, VLF, LF, HF were significant differences (P<0.05), SDANN, PNN50, LF/HF had no significant difference; in the Non-organic heart disease and organic heart disease groups, SDNN, SDANN, RMSSD, PNN50, VLF, LF, HF, LF/HF were not significantly different. Older group: the two groups and compared to the control group, SDNN, RMSSD, VLF, LF, HF were significant differences (P<0.05), SDANN, PNN50, LF/HF had no significant difference; in the Non-organic heart disease and organic heart disease groups, LF/HF were significantly different (P<0.05); SDNN, SDANN, RMSSD, PNN50, VLF, LF, HF were not significantly different. SDNN, RMSSD, PNN50, VLF, LF, HF in Non-organic heart disease group and organic heart disease group there was no significant difference.5. Waking period and Sleeping period comparison Young group: Group of non-organic heart disease: SDANN, PNN50 and LF/HF were significantly different (P<0.05), SDNN, RMSSD, VLF, LF, HF had no significant difference. Group of organic heart disease: SDANN, PNN50 and LF/HF were significantly different (P<0.05), SDNN, RMSSD, VLF, LF, HF had no significant difference. Group of control: SDNN, RMSSD, PNN50, LF, HF were significantly different, SDANN, VLF, LF/HF had no significant difference. Older group: Group of non-organic heart disease: SDANN, PNN50 and LF/HF were significantly different (P<0.05), SDNN, RMSSD, VLF, LF, HF had no significant difference; Group of organic heart disease: PNN50 had significant difference (P<0.05), SDNN, SDANN, RMSSD, VLF, LF, HF, LF/HF showed no significant difference. Group of control: SDNN, RMSSD, PNN50, LF, HF were significantly different, SDANN, VLF, LF/HF had no significant difference.Conclusions1. Atrioventricular block was not all organic diseases, which can be found in normal children. As a result of unstable autonomic nervous function, vagus nerve hyperfunction was more easily occurs. 2. Organic atrioventricular block has different performance of the HRV in different situations.3. HRV analysis of non-invasive and easy-to-use could be used as a reference indicator to identify the clinical significance of atrioventricular conduction block in children. |
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