Heart rate variability after video-assisted thoracoscopic surgery lobectomy

Background: Heart rate variability (HRV) is a measurement of autonomic nervous system functioning and is potentially related to hypotension, postoperative atrial fibrillation, and orthostatic intolerance. However, there is a lack of knowledge on which specific time points and indices to measure. To improve future study design, there is a need for procedure-specific studies in an enhanced recovery video-assisted thoracic surgery (VATS) lobectomy setting, and for continuous measurement of perioperative HRV. Methods: HRV was measured continuously from 2 days before until 9 days after VATS lobectomy in 28 patients. Patients filled out the Orthostatic Discriminant and Severity Scale 4 times during the study to describe the symptom burden possibly related to autonomic nervous system dysfunction. Results: After VATS lobectomy, with median length of stay = 4 days, the standard deviation between normal-to-normal beats and the total power of HRV were reduced for 8 days during the night and day times, while low-to-high frequency variation and detrended fluctuation analysis were stable. An increase in orthostatic intolerance was potentially related to HRV. There was an increase in pain, weakness, and fatigue. Two patients developed postoperative atrial fibrillation Conclusions: This is the first detailed study to show that HRV measures of total variability was reduced following fast-track VATS lobectomy, while other measures were more stable. Further, preoperative HRV measures showed circadian variation. Preoperative HRV as a risk factor for postoperative orthostatic intolerance and atrial fibrillation requires further study. The results demonstrate a valid design platform for future HRV studies in relation to postoperative outcomes.