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Based upon the hypothesis that prognosis in childhood heart failure depends on autonomic dysfunction, the author introduced a new heart failure model and a medical therapy with beta-blockers in 1996. The author used the analysis of heart rate variability (HRV) in 24 hours Holter ECG's for the understanding of the pathophysiology of childhood heart failure and for objective control of medical therapy. The success of this clinical model was the inspiration of a new approach to mental disease in childhood. In the last decades, an increase of new paediatric problems requiring medical care like eating disorders, behavioural and attention problems has been observed. All these diseases are related to autonomic dysfunction and have a high impact on cardiovascular prognosis. Based upon the hypothesis that behavioural problems are accompanied by changes in the autonomic nervous system, the author performed analysis of HRV in 24 hours Holter ECG's in these patient groups: healthy children with respect to school affiliation; a historical control group from literature published in 1997; attention deficit disorder with and without hyperactivity; anorexia nervosa and obesity. This data was compared to children with an increased cardiovascular risk due to congenital heart disease. In order to analyse the effect of autonomic function on human growth, we measured HRV in children with growth failure. A new HRV Score was established for the comparison of autonomic function in different age groups. The author could demonstrate a decrease of vagal activity in healthy children in children of today and speculate that insufficient vagal maturation may be a reason for an increasing prevalence of mental and cardiovascular disease. Looking for the reason of this vagal shift, caloric over nutrition, omega-3-fatty acid deficiency, high intensity of information and communication technology usage and some environmental toxins reduce HRV in childhood.
Heart rate variability (HRV) analysis is a powerful non-invasive tool used to determine the state of the heart and assess the development of the Autonomic Nervous System (ANS). The reduced HRV has been associated with negative outcome of ANS. This work describes the results obtained by HRV analysis of two groups of children, 41 Intrauterine growth retarded (IUGR) and 34 normal for a period of 24 hours. The main objective of this work was to explore the autonomic control in IUGR children by performing HRV analysis and comparing the results with normal children to find differences in HRV at 10 years of age. Barker theory and hypothesis states that the IUGR can be prone to coronary heart diseases or hypertension in their adulthood. Signal processing was performed on the ECG signal (data) provided which included filtering and detecting the QRS to find the RR segments. In the time domain analysis many parameters were calculated for all 75 children. Several comparisons between IUGR and normal children groups using night time and one hour RR data collected at night using several variables were computed. Frequency domain analysis of RR has been performed by autoregressive model (AR) Fast Fourier Transform (FFT) after re-sampling RR data of all 75 children. Calculation of the frequency components, large frequency, high frequency, and ratio of LF/HF, were obtained using FFT, AR and Lomb periodogram. Statistical analyses were performed to compare between IUGR and normal children. Time and frequency analysis comparison between the two groups of children showed no significant statistical differences, but the analysis has shown significant difference when dividing IUGR into IUGR1 (
Open a Window into the Autonomic Nervous SystemQuantifying the amount of autonomic nervous system activity in an individual patient can be extremely important, because it provides a gauge of disease severity in a large number of diseases. Heart rate variability (HRV) calculated from both short-term and longer-term electrocardiograms is an ideal win
This book describes newly developed methods of assessing the autonomic nervous system. Up-to-date information on microneurographic analysis of human cardiovascular and thermoregulatory function in humans, heart rate variability, and 131I-metaiodobenzylguanidine (MIBG) scintigraphy are provided. Microneurography, which was originally developed as a technique to analyze the afferent muscle spindle, came to be used to analyze sympathetic nerve activity in the mid-1980s. In the twenty-first century, this technique has become prevalent all over the world especially in investigating the pathophysiology of human cardiovascular function. It is also now used in researching human thermoregulatory function. Heart rate variability is another valuable tool in investigating the current status of human vagal function and in predicting future cardiovascular disease. MIBG is also used to assess cardiac noradrenergic function, especially decreases associated with Parkinson’s disease, Lewy body disease, and multisystem atrophy. Overviews of recent advances in these three important assessments are provided by leading experts.Clinical Assessment of the Autonomic Nervous System is a useful resource for neurologists and researchers of clinical neurophysiology.
Over the last decades, assessment of heart rate variability (HRV) has increased in various fields of research. HRV describes changes in heartbeat intervals, which are caused by autonomic neural regulation, i.e. by the interplay of the sympathetic and the parasympathetic nervous systems. The most frequent application of HRV is connected to cardiological issues, most importantly to the monitoring of post-myocardial infarction patients and the prediction of sudden cardiac death. Analysis of HRV is also frequently applied in relation to diabetes, renal failure, neurological and psychiatric conditions, sleep disorders, psychological phenomena such as stress, as well as drug and addiction research including alcohol and smoking. The widespread application of HRV measurements is based on the fact that they are noninvasive, easy to perform, and in general reproducible – if carried out under standardized conditions. However, the amount of parameters to be analysed is still rising. Well-established time domain and frequency domain parameters are discussed controversially when it comes to their physiological interpretation and their psychometric properties like reliability and validity, and the sensitivity to cardiovascular properties of the variety of parameters seems to be a topic for further research. Recently introduced parameters like pNNxx and new dynamic methods such as approximate entropy and detrended fluctuation analysis offer new potentials and warrant standardization. However, HRV is significantly associated with average heart rate (HR) and one can conclude that HRV actually provides information on two quantities, i.e. on HR and its variability. It is hard to determine which of these two plays a principal role in the clinical value of HRV. The association between HRV and HR is not only a physiological phenomenon but also a mathematical one which is due to non-linear (mathematical) relationship between RR interval and HR. If one normalizes HRV to its average RR interval, one may get ‘pure’ variability free from the mathematical bias. Recently, a new modification method of the association between HRV and HR has been developed which enables us to completely remove the HRV dependence on HR (even the physiological one), or conversely enhance this dependence. Such an approach allows us to explore the HR contribution to the clinical significance of HRV, i.e. whether HR or its variability plays a main role in the HRV clinical value. This Research Topic covers recent advances in the application of HRV, methodological issues, basic underlying mechanisms as well as all aspects of the interaction between HRV and HR.
New edition of the classic complete reference book for cardiologists and trainee cardiologists on the theory and practice of electrocardiography, one of the key modalities used for evaluating cardiology patients and deciding on appropriate management strategies.
Nerve endings in the walls of the carotid sinuses and the aortic arch transduce arterial pressure changes and provide the central nervous system with a steady stream of encoded information. On the basis of this information, efferent autonomic neural activity is modulated finely, and the neurohumoral milieu of the heart and the blood vessels is adjusted on a second-to-second basis. The arterial baroreflex may be the most important of the cardiovascular control mechanisms, because the baroreflex, above all other reflex mechanisms, is the one whose speed is most adequate to respond rapidly to the abrupt transients of arterial pressure that occur in daily life. This volume presents the many experimental methods available for use in humans that have been recently developed. Some are ingenious and yield results that earlier might have been thought impossible to obtain from human volunteers. Development of these new methods has increased the scientific credibility of human baroreflex research, and this work discusses the advances made in these studies. It clearly describes the existing deficiencies in the understanding of baroreflex mechanisms, and suggests methods for future research in this developing field.
The Poincaré plot (named after Henri Poincaré) is a popular two-dimensional visualization tool for dynamic systems due to its intuitive display of the dynamic properties of a system from a time series. This book presents the basis of Poincaré plot and focus especially on traditional and new methods for analysing the geometry, temporal and spatial dynamics disclosed by the Poincaré plot to evaluate heart rate variability (HRV). Mathematical descriptors of Poincaré plot have been developed to quantify the autonomic nervous system activity (sympathetic and parasympathetic modulation of heart rate). Poincaré plot analysis has also been used in various clinical diagnostic settings like diabetes, chronic heart failure, chronic renal failure and sleep apnea syndrome. The primary aims of quantification of the Poincaré plots are to discriminate healthy physiological systems from pathological conditions and to classify the stage of a disease. The HRV analysis by Poincaré plot has opened up ample opportunities for important clinical and research applications. Therefore, the present book can be used either for self-study, as a supplement to courses in linear and nonlinear systems, or as a modern monograph by researchers in this field of HRV analysis.
Neurofeedback is utilized by over 10,000 clinicians worldwide with new techniques and uses being found regularly. Z Score Neurofeedback is a new technique using a normative database to identify and target a specific individual's area of dysregulation allowing for faster and more effective treatment. The book describes how to perform z Score Neurofeedback, as well as research indicating its effectiveness for a variety of disorders including pain, depression, anxiety, substance abuse, PTSD, ADHD, TBI, headache, frontal lobe disorders, or for cognitive enhancement. Suitable for clinicians as well as researchers this book is a one stop shop for those looking to understand and use this new technique. - Contains protocols to implement Z score neurofeedback - Reviews research on disorders for which this is effective treatment - Describes advanced techniques and applications