Early Changes In Heart Rate Variability After Transcatheter Closure In Patients With Atrial Septal Defect And Preliminary Study Of Its Influencing Factors

Background Heart rate variability(HRV)is a non-invasive indicator that evaluates the function of the cardiac autonomic nervous system(ANS),which can be used to predict the mortality for cardiovascular disease.Studies have shown that patients with atrial septal defect(ASD)have lower HRV,while reduced HRV can be significantly improved by transcatheter closure.Factors affecting HRV in patients with ASD have not been clarified.The purpose of this study is to evaluate the changes of HRV before and after interventional closure in patients with ASD,and to identify the factors that affect these changes.Methods A total of 154 patients with ASD who underwent transcatheter closure and met the study requirements were analyzed in this study.Moreover,26 patients with patent foramen ovale(PFO)were enrolled as a control group.All patients underwent echocardiography and dynamic electrocardiogram before and one day after the procedure.Twenty patients with ASD reviewed TTE and DCG one month after the procedure.Using t-test,χ~2 test to compare the differences between the groups of data,Pearson correlation coefficient and multilinear regression model were used to evaluate factors affecting the HRV index of patients with ASD.Results HRV indicators(SDNN,SDANN,RMSSD,PNN50)in patients with ASD were significantly lower than those in the patients with PFO before closure(P<0.01),and the difference in the average heart rate between the two groups was not statistically significant(P=0.537).Compared to preoperative,patients with ASD had significantly higher SDNN and SDANN after closure(P<0.001)and lower average heart rate(P<0.01).In patients with PFO,all HRV indicators(SDNN,SDANN,RMSSD,PNN50)decreased significantly compared to pre-closure(P<0.001),with a significant increase in the average heart rate(P=0.001).There were significant correlations between HRV indicators and right chamber systolic pressure in patients with ASD(SDNN:r=-0.370,P<0.001;SDANN:r=-0.360,P<0.001;n=124).Multiple regression analyses indicated that age,sex,defect diameter,heart rate and diabetes were significantly associated with HRV indices(SDNN:R~2=0.415;P<0.001).Conclusions Patients with ASD have significantly lower HRV,and interventional closure can improve reduced HRV.Old,female,larger defects,faster heart rate,and combined diabetes are all factors contributing to the decline in HRV in patients with ASD.Furthermore,right ventricular systolic pressure plays an important role in the change in HRV.Therefore,early implementation of transcatheter closure therapy can benefit all kinds of patients with ASD.