Cardiac autonomic nervous activity in patients with transposition of the great arteries after arterial switch operation

https://doi.org/10.1016/j.ijcchd.2022.100417Get rights and content
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Highlights

  • A chronic imbalance of the autonomic nervous system may contribute to long term complications in congenital heart diseases.

  • The cardiac autonomic nervous system activity could be assessed on an outpatient basis by combining impedance cardiography and electrocardiography.

  • The sympathetic nervous system response to physical activity is reduced in patients with Transposition of the great arteries after arterial switch operation.

  • A positive correlation between better left ventricular function and higher parasympathetic activity reinforces the idea of a protective effect of a higher vagal activity.

Abstract

Background

A chronic imbalance of the autonomic nervous system(ANS) may contribute to long term complications in different congenital heart diseases. The purpose of this study was to determine whether the ANS plays a role in the long-term outcome of patients with Transposition of great arteries(TGA) after arterial switch operation(ASO) as its contribution is as yet not clear.

Methods

The ANS activity was evaluated non-invasively in 26 TGA patients and 52 age-appropriate healthy subjects combining impedance cardiography and electrocardiography. Heart rate, pre-ejection period(sympathetic activity parameter) and respiratory sinus arrhythmia and the root of the mean square of successive normal-to-normal interval differences(parasympathetic activity parameter) were measured during 5 different daily activities(sleep, sitting, active sitting, light and moderate/vigorous physical activity). Whether the ANS activity was related to ventricular function, exercise test performance or clinical outcome in the patient group was also analyzed.

Results

Compared to healthy subjects: heart rate was significantly lower in TGA patients at rest and during quiet and active sitting; sympathetic activity was significantly reduced in patients during physical activity; and the parasympathetic activity was higher in TGA patients while quiet and active sitting. In the patient group a significant positive correlation between 4-chamber longitudinal strain and parasympathetic activity during 3 different daily activities was found.

Conclusions

The sympathetic nervous system response to physical activity is reduced in TGA patients after ASO. Additionally, we observed a positive correlation between better left ventricular function and higher parasympathetic activity that could be in line with the known protective effect of a higher vagal activity.

Keywords

Transposition of the great arteries
Arterial switch operation
Autonomic nervous system
Left ventricular function

Abbreviations

Autonomic nervous system (ANS)
Arterial switch operation (ASO)
Carbon dioxide production (VCO2)
Cardiopulmonary exercise test (CPET)
Confidence interval (CI)
Congenital heart diseases (CHD)
Electrocardiography (ECG)
Heart rate (HR)
Impedance cardiography (ICG)
Intact ventricular septum (IVS)
Interquartile range (IQR)
Minute ventilation (VE)
Oxygen uptake (VO2)
Oxygen uptake efficiency slope (OUES)
Parasympathetic nervous system (PNS)
Pre-ejection period (PEP)
Respiratory exchange ratio (RER)
Root of the mean square of successive normal-to-normal interval differences (RMSSD)
Respiratory sinus arrhythmia (RSA)
Standard deviation (SD)
Sympathetic nervous system (SNS)
Transposition of the great arteries (TGA)
Left ventricle (LV)
Longitudinal strain (LS)
Ventricular septal defect (VSD)
Work rate (WR)

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This author takes responsibility for all aspects of the reliability and freedom from bias of the data presented and their discussed interpretation.