Skip to main content
    • Aa
    • Aa

Evidence for time-dependent autonomic cardiac reinnervation in children subsequent to transplantation of the heart

  • Joachim Kreuder (a1), Heinrich Netz (a1), Thomas Paul (a1), Andreas Müller (a1), Jürgen Bauer (a1) and Reinald Repp (a1)
  • DOI:
  • Published online: 01 January 1996

Autonomic denervation has been assumed to persist after orthotopic heart transplantation. Analyzing spontaneous and induced variations of heart rate, the status of autonomic cardiac innervation was investigated in six children 19–37 months after cardiac transplantation. The age at the time of transplantation varied from three weeks to 15.4 years. Heart rate variability was assessed on 24-hour Holter recordings by calculating time-domain indices (standard deviation of all RR intervals; standard deviation of the mean RR intervals from successive five-minute periods; mean of the standard deviations of RR intervals from successive five-minute periods; proportion of adjacent RR intervals > 50 msec different; square root of mean square successive differences in RR intervals) and frequency-domain variables (low frequency power, high frequency power and total spectrum power). Sinus node recovery time, sinoatrial conduction time and post-pacing cycle lengths were examined at different rates of endocardial atrial pacing. After the first year subsequent to transplantation, standard deviation of the mean RR intervals reached the normal range in four patients, whereas the other time-domain variables became normal in two patients. Both patients displayed normal or near-normal power spectrums of heart rate with normal day-to-night variations. For the remaining patients, spectrums of heart rate failed to show the main frequency peaks. Only the patient with normal variability in heart rate exhibited a decrease in corrected sinus node recovery time at higher stimulation rates, shortening of the first recovery cycle below the pre-pacing level, and a rapid decline of the accelerated post-pacing heart rate as described in innervated hearts. These results suggest the evolution of time-dependent efferent autonomic reinnervation after cardiac transplantation in children.

Corresponding author
Dr. Joachim Kreuder, Children's Hospital, Justus-Liebig University, Feulgenstraße 12, D-35385 Giessen, Germany. Tel. 49 641 702 4400; Fax. 49 641 702 4489.
Linked references
Hide All

This list contains references from the content that can be linked to their source. For a full set of references and notes please see the PDF or HTML where available.

3.SE Pope , EB Stinson , GT Daughters , JS Schroeder , NB Ingels , EL Alderman . Exercise response of the denervated heart in long-term cardiac transplant recipients. Am J Cardiol 1980; 46: 213218.

5.EL Fallen , MV Kamath , DN Ghista , D Fitchett . Spectral analysis of heart rate variability following human heart transplantation: evidence of functional reinnervation. J Auton Nerv Syst 1988; 23: 199206.

6.RF Wilson , BV Christensen , MT Olivari , A Simon , CW White , DD Laxson . Evidence of structural sympathetic reinnervation after orthotopic cardiac transplantation in humans. Circulation 1991; 83: 12101220.

7.M Schwaiger , GD Hutchins , V Kalff , K Rosenspire , MS Haka , S Mallette , GM Deeb , GD Abrams , D Wieland . Evidence for regional catecholamine uptake and storage sites in the transplanted human heart by positron emission tomography. J Clin Invest 1991; 87: 16811690.

8.AP Fitzpatrick , N Banner , A Cheng , M Yacoub , R Sutton . Vasovagal reactions may occur after orthotopic heart transplantation. J Am Coll Cardiol 1993; 21: 11321137.

10.ML Appel , RD Berger , P Saul , JM Smith , RJ Cohen . Beat to beat variability in cardiovascular variables: noise or music? J Am Coll Cardiol 1989; 14: 11391148.

11.PK Stein , MS Bosner , RE Kleiger , BM Conger . Heart rate variability: a measure of cardiac autonomic tone. Am Heart J 1994; 127: 13761381.

12.A Malliani , M Pagani , F Lombardi , S Cerutti . Cardiovascular neural regulation explored in the frequency domain. Circulation 1991; 84: 482492.

13.M Malik , AJ Camm . Heart rate variability and clinical cardiology. Br Heart J 1994; 71: 36.

14.JW Mason . Overdrive suppression in the transplanted heart: effect of the autonomic nervous system on human sinus node recovery. Circulation 1980; 62: 688696.

15.RS Bexton , AW Nathan , KJ Hellestrand , R Cory-Pearce , RAJ Spurrell , TAH English , AJ Camm . Sinoatrial function after cardiac transplantation. J Am Coll Cardiol 1984; 3: 712723.

16.PC Nalos , Z Deng , ME Rosenthal , ES Gang , DS Oseran , WJ Mandel , T Peter . Hemodynamic influences on sinus node recovery time: effects of autonomic blockade. J Am Coll Cardiol 1986; 7: 10791086.

19.D Van Hoogenhuyze , N Weinstein , GJ Martin , JS Weiss , JW Schaad , N Sahyouni , D Fintel , WJ Remme , DH Singer . Reproducibility and relation to mean heart rate of heart rate variability in normal subjects and in patients with congestive heart failure secondary to coronary heart disease. Am J Cardiol 1991; 68: 16681676.

20.GJ Martin , NM Magid , G Myers , PS Barnett , JW Schaad , JS Weiss , M Lesch , DH Singer . Heart rate variability and sudden death secondary to coronary artery disease during ambulatory electrocardiographic monitoring. Am J Cardiol 1987; 60: 8689.

21.JT Bigger , RE Kleiger , JL Fleiss , LM Rolnitzky , RC Steinman , JP Miller . Components of heart rate variability measured during healing of acute myocardial infarction. Am J Cardiol 1988; 61: 208215.

22.JT Bigger , P Albrecht , RC Steinman , L Rolnitzky , JL Fleiss , RJ Cohen . Comparison of time- and frequency domain-based measures of cardiac parasympathetic activity in Holter recordings after myocardial infarction. Am J Cardiol 1989; 64: 536538.

23.DJ Ewing , JMM Neilson , CM Shapiro , JA Stewart , W Reid . Twenty-four hour heart rate variability: effects of posture, sleep, and time of day in healthy controls and comparison with bedside tests of autonomic function in diabetic patients. Br Heart J 1991; 65: 239244.

24.J Hayano , Y Sakakibara , A Yamada , M Yamada , S Mukai , T Fujinami , K Yokoyama , Y Watanabe , K Takata . Accuracy of assessment of cardiac vagal tone by heart rate variability in normal subjects. Am J Cardiol 1991; 67: 199204.

25.JN Rottman , RC Steinman , P Albrecht , JT Bigger , LM Rolnitzky , JL Fleiss . Efficient estimation of the heart period power spectrum suitable for physiologic or pharmacologic studies. Am J Cardiol 1990; 66: 15221524.

26.K Koizumi , N Terui , M Kollai . Effect of cardiac vagal and sympathetic nerve activity on heart rate in rhythmic regulations. J Auton Nerv Syst 1985; 12: 251259.

28.H Molgaard , KE Sorensen , P Bjerregaard . Circadian variation and influence of risk factors on heart rate variability in healthy subjects. Am J Cardiol 1991; 68: 777784.

29.JT Bigger , CA Hoover , RC Steinman , LM Rolnitzky , JL Fleiss . Autonomic nervous system activity during myocardial ischemia in man estimated by power spectral analysis of heart period variability. Am J Cardiol 1990; 66: 497498.

30.OV Korkushko , VB Shatilo , YI Plachida , TV Shatilo . Autonomic control of cardiac chronotropic function in man as a function of age: assessment by power spectral analysis of heart rate variability. J Auton Nerv Syst 1991; 32: 191198.

31.HC Strauss , AL Saroff , JT Bigger , EGV Giardina . Premature atrial stimulation as a key to the understanding of sinoatrial conduction in man. Circulation 1973; 47: 8693.

32.OS Narula , N Shanth , M Vasquez , WD Towne , JW Linhart . A new method for measurement of sinoatrial conduction time. Circulation 1978; 58: 706714.

33.L Rudas , PW Pflugfelder , AH Menkis , RJ Novick , FN McKenzie , WJ Kostuk . Evolution of heart rate responsiveness after orthotopic cardiac transplantation. Am J Cardiol 1991; 68: 232236.

34.TG Pickering , B Gribbin , P Sleight . Comparison of the reflex heart rate response to rising and falling arterial pressure in man. Cardiovasc Res 1972; 6: 277283.

37.KEF Sands , ML Appel , LS Lilly , FJ Schoen , GH Mudge , RJ Cohen . Power spectrum analysis of heart rate variability in human cardiac transplant recipients. Circulation 1989; 79: 7682.

39.AF Folino , G Buja , M Miorelli , U Livi , A Nava , G Thiene , SD Volta . Heart rate variability in patients with orthotopic heart transplantation: long-term follow-up. Clin Cardiol 1993; 16: 539542.

41.F Anselme , N Saoudi , M Redonnet , B Letac . Atrioatrial conduction after orthotopic heart transplantation. J Am Coll Cardiol 1994; 24: 185189.

42.P Grossman , K Wientjes . Respiratory sinus arrhythmia and parasympathetic cardiac control: some basic issues concerning quantification, applications and implications. In: P Grossman , KHL Janssen , D Vaitl (eds). Cardiorespiratory and Cardiosomatic Psychophysiology. Plenum Press, New York, 1986, pp 117138.

43.RE Kleiger , JT Bigger , MS Boner , MK Chung , JR Cook , LM Rolnitzky , R Steinman , JL Fleiss . Stability over time of variables measuring heart rate variability in normal subjects. Am J Cardiol 1991; 68: 626630.

Recommend this journal

Email your librarian or administrator to recommend adding this journal to your organisation's collection.

Cardiology in the Young
  • ISSN: 1047-9511
  • EISSN: 1467-1107
  • URL: /core/journals/cardiology-in-the-young
Please enter your name
Please enter a valid email address
Who would you like to send this to? *