QT dynamicity, microvolt T-wave alternans, and heart rate variability during 24-hour ambulatory electrocardiogram monitoring in the healthy newborn of first to fourth day of life

Makarov, Leonid; Komoliatova, Vera; Zevald, Svetlana; Schmidt, George; Muller, Аlexander; Serebruany, Victor

doi:10.1016/j.jelectrocard.2009.11.001

« Previous Next »Journal of Electrocardiology
Volume 43, Issue 1 , Pages 8-14, January 2010

QT dynamicity, microvolt T-wave alternans, and heart rate variability during 24-hour ambulatory electrocardiogram monitoring in the healthy newborn of first to fourth day of life

Leonid Makarov
- Center for Syncope and Cardiac Arrhythmias in Children and Adolescents of the Federal Medical-biological Agency of Russia, Children's Clinical Hospital No. 38 of FMBA of Russia, Moscow, Russia
- Corresponding author. Center for Syncope and Cardiac Arrhythmias in Children and Adolescents of the Federal Medical-biological Agency of Russia, Children's Clinical Hospital No. 38 of FMBA of Russia, Moscow, 115409 Russia.
Vera Komoliatova
- Center for Syncope and Cardiac Arrhythmias in Children and Adolescents of the Federal Medical-biological Agency of Russia, Children's Clinical Hospital No. 38 of FMBA of Russia, Moscow, Russia
Svetlana Zevald
- Maternity Hospital No. 15 of Moscow Healthcare Department, Moscow, Russia
George Schmidt
- Department of Noninvasive Electrophysiology of the Centre of Heart Diseases, Technological University, Munich, Germany
Аlexander Muller
- Department of Noninvasive Electrophysiology of the Centre of Heart Diseases, Technological University, Munich, Germany
Victor Serebruany
- Johns Hopkins University Baltimore, Maryland, USA

Received 10 September 2009

Abstract

Background

Twenty-four hour ambulatory electrocardiogram (AECG) monitoring is an established technique for integrated assessment of heart rhythm; however, comprehensive description of serial changes in cardiac electrophysiology over the first days of life in humans is lacking. The aim of this study was to determine the patterns of circadian heart rhythm based on AECG evaluation in newborns.

Methods

Twenty healthy newborns (14 boys and 6 girls) were serially examined with AECG at days 1, 2, and 4 after birth. Heart rate (HR), arrhythmias, QT dynamicity, microvolt T-wave alternans, and various indices of HR variability (HRV) including deceleration/acceleration capacity analysis were analyzed.

Results

There were no sex differences in HR. Supraventricular premature beats were noted in 35%, ventricular—in 15 % of newborns. Slope QT/RR was 0.35 (0.3-0.5); intercept QT/RR was 124 (93-148), QT/RR correlation coefficient (r) was 0.63 (0.53-0.85). Peak value of T-wave alternans was 32 ± 8 (12-55) μV. Low level of HRV was typical for all parameters of time-domain analysis compared with normal limits for older children. The overall mean values of deceleration/acceleration capacity were 3.38 ± 0.57 (2.16-4.13) and −3.58 ± 0.67 (−2.13 to −4.38) milliseconds, respectively.

Conclusion

The healthy newborns exhibit peculiarities of 24-hour cardiac rhythm with isolated premature beats, pauses of sinus rhythm less 1000 milliseconds, steep slope of QT/RR by analysis of QT dynamicity. There are low HRV, and symmetrical AC/DC capacity was typically for autonomic regulation of HR, probably due to high sympathetic activity at this age.

Keywords: Heart rhythm, Newborn, Holter monitoring