Key result
Repaired VSD in older adults is linked to ~39 ms lower 24-hour HRV vs controls.
Why the study?
Although impaired heart rate variability and other abnormal parameters have been described in younger adults with congenital VSDs, it was unknown whether these abnormalities deteriorate with age in patients over 40 years.
Cross-Sectional (n=120)
No
Answers are grounded in this paper and cite their sources.
May warrant arrhythmia surveillance in older closed-VSD adults; leaves open prognostic impact and need for prospective trials.
Background Congenital ventricular septal defects (VSDs) are considered to have benign long‐term outcome when treated correctly in childhood. However, abnormal parameters are described in younger adults, including impaired heart rate variability (HRV). It is not known whether such abnormalities will deteriorate with age. Therefore, HRV and cardiac events, such as premature ventricular contraction, were evaluated in patients aged >40 years with congenital VSDs and compared with healthy peers. Methods and Results A total of 30 surgically closed VSDs (51±8 years, repair at median age 6.3 years with total range 1.4–54 years) with 30 healthy controls (52±9 years) and 30 small, unrepaired VSDs (55±12 years) with 30 controls (55±10 years) were all equipped with a Holter monitor for 24 hours. Compared with healthy peers, surgically closed patients had lower SD of the normal‐to‐normal (NN) interbeat interval (129±37 versus 168±38 ms; P <0.01), SD of the average NN intervals for each 5‐minute segment of a 24‐hour HRV recording (116±35 versus 149±35 ms; P <0.01) and 24‐hour triangular index (31±9 versus 44±11; P <0.01). SD of the NN intervals, SD of the average NN intervals for each 5‐minute segment of a 24‐hour HRV recording, and triangular index were comparable between unrepaired VSDs and healthy peers. SD of the NN intervals was <100 ms in 22% of surgically closed and 10% of unrepaired VSDs, whereas controls were within normal ranges. A high number of premature ventricular contractions (>200 events) was registered in 57% of surgical patients compared with 3% of controls ( P <0.01), and 53% of unrepaired VSDs compared with 10% in controls ( P <0.01). Conclusions Adults aged >40 with congenital VSDs demonstrate impaired HRV, mainly among surgically closed VSDs. More than half demonstrated a high number of premature ventricular contractions. These novel findings could indicate long‐term cardiovascular disturbances. This necessitates continuous follow‐up of VSDs throughout adulthood.
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Maagaard et al. (2021) conducted a cross-sectional in Congenital ventricular septal defect (VSD) (n=120). Congenital ventricular septal defect (surgically closed or unrepaired) vs. Age- and sex-matched healthy controls was evaluated on Standard deviation of the normal-to-normal interbeat intervals (SDNN, ms) over 24 hours (surgically closed VSD vs healthy controls) (p=<0.01). Adults >40 years with surgically closed VSDs had significantly lower 24-hour heart rate variability (SDNN 129 vs 168 ms, P<0.01) and more frequent PVCs (57% vs 3%, P<0.01) than healthy peers.
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