Heart rate variability in Egyptian children with acute rheumatic fever

Introduction

Autonomic dysfunction in relation to cardiovascular system morbidity and mortality has been reported. The objective of this study was to study cardiac autonomic balance and heart rate variability (HRV) indices in acute rheumatic fever.

Methods

A prospective study was conducted on three groups. Group I included 20 patients with acute rheumatic carditis. Group II included 20 patients with no cardiac involvement (10 with chorea (Group IIa) and 10 with arthritis (Group IIb)). Group I included 10 in failure (Group Ia) and 10 compensated (Group Ib). Group III included 20 healthy controls. Plasma norepinephrine (NE) assay, echocardiography, cardiovascular autonomic function tests (5AFTs) and 24-hour ambulatory ECG (Holter) monitoring for arrhythmias and HRV. Studied HRV variables included the standard deviation of all normal RR intervals (SDNN) and the percentage of differences between adjacent normal RR intervals that are greater than 50 ms (PNN50).

Results

Group I had significantly higher values for 5AFTs score, NE, supraventricular premature beats (SVPBS) and ventricular premature beats (VPBS) (P < 0.001). Measured variables were more affected in Group Ia compared with Group Ib (Table 1) and in patients with heart failure New York Heart Association class IV compared with class Group III.

Table 1 (abstract P333)

Conclusion

Acute rheumatic carditis is associated with significant autonomic dysfunction. HRV indices can be used for risk stratification in those patients.