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Canadian Journal of Anesthesia 51:A52 (2004)
© Canadian Anesthesiologists' Society, 2004

Abstracts - Tuesday June 22nd 2004 0800-1000

HEART RATE VARIABILITY: PREDICTOR OF CARDIAC MORBIDITY AFTER CABG SURGERY

Hyun Ju Jung, MD, Dmitri Chamchad, MD, George Djaiani, MD, Jo Carroll, RN, Jacek Karski, MD and Valerie Arkoosh, MD

Department of Anesthesia, Toronto General Hospital, University Health Network, University of Toronto, 200 Elizabeth street, Toronto, Ontario, M5G 2C4

INTRODUCTION: The objective of this study was to determine if preoperative heart rate variability (HRV) is a predictor of postoperative arrhythmias in patients undergoing coronary artery bypass graft (CABG) surgery.

METHODS: After REB approval, 76 patients scheduled for elective CABG surgery underwent 10-min electrocardiogram recordings 1–2 hours prior to surgery. Patients with a previous history of heart surgery, atrial fibrillation, sinus node dysfunction, or requiring pacemaker were excluded. Time Domain, spectral and point correlation dimension (PD2) analysis were used to calculate HRV. The incidence of heart rhythm abnormalities were documented daily for 5 days post operatively. Based on presence of postoperative arrhythmia patients were categorized into two groups; arrhythmia group and controls.

RESULTS: 22 out 76 patients developed postoperative arrhythmias. Patients in arrhythmia group were significantly older (65 ± 9 vs. 58 ± 11 yrs, p=0.0046). High baseline peak point correlational dimension 2 (pPD2) was a risk factor for developing postoperative arrhythmias (4.2±0.8 vs. 3.8±0.7, p=0.042, FigureGo below). Low and high frequency ratio was lower in the arrhythmia group (3.0 ±2.45 vs.4.25 ±3.70, p= 0.085). There was no difference with respect to gender, inotropic use, cardiopulmonary bypass and cross-clamp time between the two groups.



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  		Figure 1. Phase Portrait of Heart Rate Variability

This Phase portrait reflects heart rate variations, by plotting each R-R interval(RRj) against the immediately following one(RRj+1). This relationship is the first step in the algorithms used in non-linear analysis. The dark blue points represent the data from one patient with high HRV index, while the bright pink points were collected from the Pt with low HRV.

 
DISCUSSION: Postoperative arrhythmia is a common morbidity after cardiac surgery. Disruption of autonomic balance between sympathetic and parasympathetic nervous systems may be one of the etiological factors involved. The pPD2 (analyzing HRV) appears to be a promising and novel predictor of post-operative arrhythmia in patients undergoing cardiac surgery.





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