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Evaluation of cardiac autonomic function using heart rate variability in children with acute carbon monoxide poisoning

Published online by Cambridge University Press:  01 August 2017

Cagdas Vural ,
Ener Cagri Dinleyici ,
Pelin Kosger ,
Ozge Bolluk ,
Zubeyir Kilic  and
Birsen Ucar
Cagdas Vural
Affiliation:
Department of Pediatrics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
Ener Cagri Dinleyici*
Affiliation:
Department of Pediatric Intensive Care, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
Pelin Kosger
Affiliation:
Department of Pediatric Cardiology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
Ozge Bolluk
Affiliation:
Department of Biostatistics, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
Zubeyir Kilic
Affiliation:
Department of Pediatric Cardiology, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
Birsen Ucar
Affiliation:
Department of Pediatric Intensive Care, Faculty of Medicine, Eskisehir Osmangazi University, Eskisehir, Turkey
*
Correspondence to: E. C. Dinleyici, Professor in Pediatrics, Department of Pediatric Intensive Care, Faculty of Medicine, Eskisehir Osmangazi University, TR-26480 Eskisehir, Turkey. Tel: + 90 222 2392979; Fax: + 90 222 2290064; E-mail: [email protected]
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Abstract

Introduction

Carbon monoxide poisoning may cause myocardial toxicity and cardiac autonomic dysfunction, which may contribute to the development of life-threatening arrhythmias. We investigated the potential association between acute carbon monoxide exposure and cardiac autonomic function measured by heart rate variability.

Method

The present study included 40 children aged 1–17 years who were admitted to the Pediatric Intensive Care Unit with acute carbon monoxide poisoning and 40 healthy age- and sex-matched controls. Carboxyhaemoglobin and cardiac enzymes were measured at admission. Electrocardiography was performed on admission and discharge, and 24-hour Holter electrocardiography was digitally recorded. Heart rate variability was analysed at both time points – 24-hour recordings – and frequency domains – from the first 5 minutes of intensive care unit admission.

Results

Time domain and frequency indices such as high-frequency spectral power and low-frequency spectral power were similar between patient and control groups (p>0.05). The ratio of low-frequency spectral power to high-frequency spectral power was significantly lower in the carbon monoxide poisoning group (p<0.001) and was negatively correlated with carboxyhaemoglobin levels (r=−0.351, p<0.05). The mean heart rate, QT dispersion, corrected QT dispersion, and P dispersion values were higher in the carbon monoxide poisoning group (p<0.05) on admission. The QT dispersion and corrected QT dispersion remained longer in the carbon monoxide poisoning group compared with controls on discharge (p<0.05).

Conclusion

The frequency domain indices, especially the ratio of low-frequency spectral power to high-frequency spectral power, are useful for the evaluation of the cardiac autonomic function. The decreased low-frequency spectral power-to-high-frequency spectral power ratio reflects a balance of the autonomic nervous system, which shifted to parasympathetic components.

Keywords

Carbon monoxide poisoningchildrenheart rate variability
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 9 , November 2017 , pp. 1662 - 1669
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Copyright
© Cambridge University Press 2017 

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References

1. Olson, K, Smollin, C. Carbon monoxide poisoning (acute). BMJ Clin Evid 2008; 07: pii:2103.Google Scholar
2. Raub, JA, Mathieu Nolf, M, Hampson, NB, Thom, SR. Carbon monoxide poisoning – a public health perspective. Toxicology 2000; 145: 1–14.Google Scholar
3. Hampson, NB. Emergency department visits for carbon monoxide poisoning in the Pacific Northwest. J Emerg Med 1998; 16: 695–698.CrossRefGoogle ScholarPubMed
4. Kao, LW, Nañagas, KA. Carbon monoxide poisoning. Med Clin North Am 2005; 89: 1161–1194.Google Scholar
5. Akköse, S, Türkmen, N, Bulut, M, Akgöz, S, İşçimen, R, Eren, B. An analysis of carbon monoxide poisoning cases in Bursa, Turkey. East Mediterr Health J 2010; 16: 101–106.CrossRefGoogle ScholarPubMed
6. Kırel, B, Ünlüoğlu, İ, Doğruel, N, Koçak, K. Eskişehir Bölgesi’nde çocukluk çağı zehirlenmelerinin retrospektif analizi. T Klin Pediatri 2000; 9: 158–163.Google Scholar
7. Akbay-Öntürk, Y, Uçar, B. Eskişehir bölgesinde çocukluk çağı zehirlenmelerinin retrospektif değerlendirilmesi. Çocuk Sağlığı ve Hastalıkları Dergisi 2003; 46: 103–113.Google Scholar
8. Yarar, C, Yakut, A, Akın, A, Yıldız, B, Dinleyici, EC. Analysis of the features of acute carbon monoxide poisoning and hyperbaric oxygen therapy in children. Turk J Pediatr 2008; 50: 235–241.Google Scholar
9. Ernst, A, Zibrak, JD. Carbon monoxide poisoning. N Engl J Med 1998; 339: 1603–1608.Google Scholar
10. Dales, R, Air Pollution-Cardiac Health Research Group. Ambient carbon monoxide may influence heart rate variability in subjects with coronary artery disease. J Occup Environ Med 2004; 46: 1217–1221.Google Scholar
11. Gold, DR, Litonjua, A, Schwartz, J, et al. Ambient pollution and heart rate variability. Circulation 2000; 101: 1267–1273.Google Scholar
12. Tarkiainen, TH, Timonen, KL, Vanninen, EJ, Alm, S, Hartikainen, JE, Pekkanen, J. Effect of acute carbon monoxide exposure on heart rate variability in patients with coronary artery disease. Clin Physiol Funct Imaging 2003; 23: 98–102.CrossRefGoogle ScholarPubMed
13. Holguín, F, Téllez-Rojo, MM, Hernández, M, et al. Air pollution and heart rate variability among the elderly in Mexico City. Epidemiology 2003; 14: 521–527.CrossRefGoogle ScholarPubMed
14. Vanderlei, LC, Pastre, CM, Hoshi, RA, Carvalho, TD, Godoy, MF. Basic notions of heart rate variability and its clinical applicability. Rev Bras Cir Cardiovasc 2009; 24: 205–217.Google Scholar
15. Kardelen, F, Tezcan, G, Akçurin, G, Ertuğ, H, Yeşilipek, A. Heart rate variability in patients with thalassemia major. Pediatr Cardiol 2008; 29: 935–939.Google Scholar
16. Gil, E, Vergara, JM, Bianchi, AM, Laguna, P. Obstructive sleep apnea syndrome analysis in children by decreases in the amplitude fluctuations of pulse photoplethysmography: role of recording duration and heart rate variability. Conf Proc IEEE Eng Med Biol Soc 2007; 2007: 6090–6093.Google Scholar
17. Taşçılar, ME, Yokuşoğlu, M, Boyraz, M, Baysan, O, Köz, C, Dündaröz, R. Cardiac autonomic functions in obese children. J Clin Res Pediatr Endocrinol 2011; 3: 60–64.Google Scholar
18. Grutter, G, Giordano, U, Alfieri, S, et al. Heart rate variability abnormalities in young patients with dilated cardiomyopathy. Pediatr Cardiol 2012; 33: 1171–1174.CrossRefGoogle ScholarPubMed
19. Kılıç, A, Gülgün, M, Taşçılar, ME, Sarı, E, Yokuşoğlu, M. Cardiac autonomic regulation is disturbed in children with euthyroid Hashimoto thyroiditis. Tohoku J Exp Med 2012; 226: 191–195.Google Scholar
20. Tonhajzerova, I, Ondrejka, I, Adamik, P, et al. Changes in the cardiac autonomic regulation in children with attention deficit hyperactivity disorder (ADHD). Indian J Med Res 2009; 130: 44–50.Google Scholar
21. Tiinanen, S, Määttä, A, Silfverhuth, M, Suominen, K, Jansson-Verkasalo, E, Seppänen, T,. HRV and EEG based indicators of stress in children with Asperger syndrome in audio-visual stimulus test. Conf Proc IEEE Eng Med Biol Soc 2011; 2011: 2021–2024.Google Scholar
22. Emin, O, Esra, G, Ayşegül, D, Ufuk, E, Ayhan, S, Ruşen, DM. Autonomic nervous system dysfunction and their relationship with disease severity in children with atopic asthma. Respir Physiol Neurobiol 2012; 183: 206–210.Google Scholar
23. Inoue, M, Mori, K, Hayabuchi, Y, Tatara, K, Kagami, S. Autonomic function in patients with Duchenne muscular dystrophy. Pediatr Int 2009; 51: 33–40.Google Scholar
24. Boysen, A, Lewin, MA, Hecker, W, Leichter, HE, Uhlemann, F. Autonomic function testing in children and adolescents with diabetes mellitus. Pediatr Diabetes 2007; 8: 261–264.Google Scholar
25. Dinleyici, EC, Kilic, Z, Sahin, S, et al. Heart rate variability in children with tricyclic antidepressant intoxication. Cardiol Res Pract 2013; 2013: 196506.Google Scholar
26. Liao, D, Creason, J, Shy, C, Williams, R, Watts, R, Zweidinger, R. Daily variation of particulate air pollution and poor cardiac autonomic control in the elderly. Environ Health Perspect 1999; 107: 521–525.Google Scholar
27. Riojas-Rodríguez, H, Escamilla-Cejudo, JA, González-Hermosillo, JA, et al. Personal PM2.5 and CO exposures and heart rate variability in subjects with known ischemic heart disease in Mexico City. J Expo Sci Environ Epidemiol 2006; 16: 131–137.Google Scholar
28. Seely, AJ, Macklem, PT. Complex systems and the technology of variability analysis. Crit Care 2004; 8: R367–R384.Google Scholar
29. Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. Circulation 1996; 93:1043–1065.Google Scholar
30. Min, JY, Paek, D, Cho, SI, Min, KB. Exposure to environmental carbon monoxide may have a greater negative effect on cardiac autonomic function in people with metabolic syndrome. Sci Total Environ 2009; 407: 4807–4811.Google Scholar
31. Chen, PS, Tan, AY. Autonomic nerve activity and atrial fibrillation. Heart Rhythm. 2007; 4: S61–S64.CrossRefGoogle ScholarPubMed
32. Teksam, O, Gümuş, P, Bayrakçı, B, Erdoğan, I, Kale, G. Acute cardiac effects of carbon monoxide poisoning in children. Eur J Emerg Med 2010; 17: 192–196.Google Scholar
33. Schwartz, J. Air pollution and hospital admissions for heart disease in eight U.S. counties. Epidemiology 1999; 10: 17–22.CrossRefGoogle ScholarPubMed
34. Andre, L, Boissière, J, Reboul, C, et al. Carbon monoxide pollution promotes cardiac remodeling and ventricular arrhythmia in healthy rats. Am J Respir Crit Care Med 2010; 181: 587–595.Google Scholar
35. Lippi, G, Rastelli, G, Meschi, T, Borghi, L, Cervellin, G. Pathophysiology, clinics, diagnosis and treatment of heart involvement in carbon monoxide poisoning. Clin Biochem 2012; 45: 1278–1285.Google Scholar
36. Yelken, B, Tanrıverdi, B, Çetinbaş, F, Memiş, D, Süt, N. The assessment of QT intervals in acute carbon monoxide poisoning. Anadolu Kardiyol Derg 2009; 9: 397–400.Google Scholar
37. Sarı, İ, Zengin, S, Özer, O, Davutoğlu, V, Yıldırım, C, Aksoy, M. Chronic carbon monoxide exposure increases electrocardiographic P-wave and QT dispersion. Inhal Toxicol 2008; 20: 879–884.CrossRefGoogle ScholarPubMed
38. Hancı, V, Ayoğlu, H, Yurtlu, S, et al. Effects of acute carbon monoxide poisoning on the P-wave and QT interval dispersions. Anadolu Kardiyol Derg 2011; 1: 48–52.Google Scholar
39. Gürkan, Y, Canatay, H, Toprak, A, Ural, E, Toker, K. Carbon monoxide poisoning – a cause of increased QT dispersion. Acta Anaesthesiol Scand 2002; 46: 180–183.Google Scholar
40. Macmillan, CS, Wildsmith, JA, Hamilton, WF. Reversible increase in QT dispersion during carbon monoxide poisoning. Acta Anaesthesiol Scand 2001; 45: 396–397.Google Scholar
41. Higham, PD, Campbell, RW. QT dispersion. Br Heart J 1994; 71: 508–510.Google Scholar
42. Stoletniy, LN, Pai, SM, Platt, ML, Torres, VI, Pai, RG. QT dispersion as a noninvasive predictor of inducible ventricular tachycardia. J Electrocardiol 1999; 32: 173–177.Google Scholar
43. Dilaveris, PE, Gialafos, JE. P-wave dispersion: a novel predictor of paroxysmal atrial fibrillation. Ann Noninvasive Electrocardiol 2001; 6: 159–165.Google Scholar
44. Kalay, N, Özdoğru, I, Çetinkaya, Y, et al. Cardiovascular effects of carbon monoxide poisoning. Am J Cardiol 2007; 99: 322–324.Google Scholar