Elsevier

The Journal of Pediatrics

Volume 135, Issue 3, September 1999, Pages 363-366
The Journal of Pediatrics

Evaluation of neurocardiac signals in pediatric patients with cyclic vomiting syndrome through power spectral analysis of heart rate variability☆,☆☆,★

https://doi.org/10.1016/S0022-3476(99)70135-6Get rights and content

Abstract

Objective: To investigate autonomic regulation of neurocardiac signals in pediatric patients with cyclic vomiting syndrome (CVS). Methods: Fourteen patients with CVS, ages 3 to 16 years, were screened to eliminate any underlying cause for their symptoms, although 11 of the 14 patients had a history of migraine in the immediate family. Analysis of autonomic regulation was accomplished through power spectral analysis of the beat-to-beat heart rate variability signal. Data from affected patients were compared with data from 38 control subjects, ages 5 to 16 years, by a one-way analysis of variance. A measure of sympathovagal balance was obtained by computing a ratio of power in the low-frequency band (0.02-0.15 Hz) to the power in the high-frequency band (0.15-0.4 Hz). Results: Pediatric patients with CVS have an elevated sympathetic modulation of the sinus node as represented by the low frequency/high frequency ratio (1.45 ± 0.42 in patients vs 0.89 ± 0.29 in healthy control subjects, P < .001). Conclusions: The patients with CVS we studied have an autonomic imbalance with enhanced sympathetic and diminished parasympathetic vagal modulation of the heart. (J Pediatr 1999;135:363-6)

Section snippets

Subjects

We studied 14 pediatric patients with CVS (9 boys and 5 girls) and 38 healthy control subjects (20 boys and 18 girls). The patients ranged in age from 3 to 16 years (mean, 9.0 ± 4.0 years), and the control subjects ranged in age from 5 to 16 years (mean, 11.2 ± 3.2 years). Patients were evaluated by means of routine blood work (14/14), metabolic screening in urine and blood (14/14), ultrasound examination of the abdomen (8/14), gastrointestinal endoscopy (9/14), radiography (12/14), 24-hour pH

RESULTS

A total of 14 patients were evaluated in their passive state (between vomiting episodes), and of these, 4 were also evaluated in their active states (during vomiting episodes). The data for the active period were considered to be unreliable because pain and vomiting during the recording resulted in artifacts on the electrocardiogram. Therefore the data collected during the active period were excluded from further analysis and only the data from the passive period are presented.

The power

DISCUSSION

There are a number of similarities between CVS and migraine, especially with regard to the periodicity of clinical symptoms and quantitative electroencephalographic changes.2 Classical migraine headaches replace CVS symptoms in 33% of the patients with CVS who do not experience resolution of symptoms by the age of 18 years.12 Recent studies on patients with migraine have attributed the symptoms to a dysfunction of the ANS.13, 14, 15

Our study suggests that pediatric patients with CVS demonstrate

Acknowledgements

We acknowledge the assistance of Dr Gervais Tougas in the success of this project.

References (16)

  • M Pagani et al.

    Spectral analysis of heart rate variability in the assessment of autonomic diabetic neuropathy

    J Auton Nerv Syst

    (1988)
  • A Aggarwal et al.

    Irritable bowel syndrome may be influenced by the autonomic nervous system

    Gastroenterology

    (1994)
  • D. Forbes

    Differential diagnosis of cyclic vomiting syndrome

    J Pediatr Gastroentrol Nutr

    (1995)
  • DNK Symon et al.

    The relationship between cyclic vomiting syndrome and abdominal migraine

    J Pediatr Gastroenterol Nutr

    (1995)
  • BUK. Li

    Cyclic Vomiting: the pattern and syndrome paradigm

    J Pediatr Gastroentrol Nutr

    (1995)
  • LL Thomsen et al.

    The autonomic nervous system and the regulation of arterial tone in migraine [review]

    Clin Auton Res

    (1995)
  • LL Thomsen et al.

    Transcranial Doppler and cardiovascular responses during cardiovascular autonomic tests in migraineurs during and outside attacks

    Brain

    (1995)
  • M Kamath et al.

    Power spectral analysis of heart rate variability: a noninvasive signature of cardiac autonomic function

    Crit Rev Biomed Eng

    (1993)
There are more references available in the full text version of this article.

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Supported by Cyclic Vomiting Syndrome Association (CVSA). Dr Kamath received support from the Natural Sciences and Engineering Research Council of Canada and Heart and Stroke Foundation of Canada.

☆☆

Reprint requests: Robert M. Issenman, MD, Room 3F31, Children’s Hospital Pediatric Gastroenterology, Hamilton Health Sciences Corporation, 1200 Main St West, Hamilton, Ontario, Canada, L8N 3Z5.

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