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CARDIOVASCULAR ANESTHESIA

Long-Term Alterations of Heart Rate Dynamics After Coronary Artery Bypass Graft Surgery

Timo T. Laitio, MD^*, Heikki V. Huikuri, MD, Juha Koskenvuo, MD, Jouko Jalonen, MD^*, Timo H. Mäkikallio, MD, Hans Helenius, MSc, Erkki S.H. Kentala, MD^*, Jaakko Hartiala, MD, and Harry Scheinin, MD^¶

Departments of *Anesthesiology and Intensive Care and Clinical Physiology, Turku University Hospital; Departments of Biostatistics and ¶Pharmacology and Clinical Pharmacology, Turku PET Centre, University of Turku; and Division of Cardiology, Department of Medicine, Oulu University Hospital, Finland

Address correspondence and reprint requests to Timo Laitio, MD, Department of Anesthesiology and Intensive Care, Turku University Hospital, P.O.B. 52, FIN-20521 Turku, Finland. Address e-mail to timo.laitio{at}tyks.fi.

We tested the hypothesis that there may be long-term alterations in overall heart rate (HR) variability and in fractal HR behavior after coronary artery bypass graft (CABG) surgery. Reduced HR variability predicts morbidity in various patient populations. Continuous 24-h electrocardiograph recordings were performed in 25 elective CABG surgery patients 1 wk before the operation and 6 wk and 6 mo after. Seventeen of the patients also had recordings 12 mo after CABG. Time and frequency domain measures of HR variability were assessed, along with measurement of short-term fractal scaling exponent (₁), approximate entropy, and power-law relationship of relative risk interval variability (ß-slope). The high, low, very low, and ultra low frequency powers decreased significantly after the operation and remained at a significantly decreased level 6 wk and 6 and 12 mo after the operation than before (P = 0.01, P < 0.001, P < 0.001, and P < 0.001 for overall difference between the time points, respectively). The fractal scaling exponent ₁ was at significantly more decreased 6 wk after (P < 0.05) CABG than before surgery but recovered to the preoperative level 6 mo after the operation. Long-term fractal organization (ß-slope) remained stable, but the overall complexity (approximate entropy) decreased toward more predictable HR dynamics during the study period (P < 0.01 after 1 yr). The predictive value of temporary and persistent long-term changes of the HR dynamics after CABG surgery for long-term outcome is not clear.

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				T. Laitio, J. Jalonen, T. Kuusela, and H. Scheinin The Role of Heart Rate Variability in Risk Stratification for Adverse Postoperative Cardiac Events Anesth. Analg., December 1, 2007; 105(6): 1548 - 1560. [Abstract] [Full Text] [PDF]

Anesthesia & Analgesia® is published for the International Anesthesia Research Society® by Lippincott Williams & Wilkins with the assistance of Stanford University Libraries' HighWire Press®. Copyright 2006 by the International Anesthesia Research Society. Online ISSN: 1526-7598   Print ISSN: 0003-2999