What is the clinical evidence from this study?

Study design: Systematic Review. Population: Coronary artery disease undergoing CABG. Intervention: Coronary artery bypass grafting (CABG) vs. Pre-operative status. Primary outcome: Heart rate variability (HRV) changes.

January 22, 2024Open Access

Heart Rate Variability and Coronary Artery Bypass Grafting: A Systematic Review

Key Result

Time and frequency domain heart rate variability parameters decrease acutely after coronary artery bypass grafting but recover almost completely to pre-operative values by 6 months after surgery.

Study Design

Type

Systematic Review

Structured PICO

Does heart rate variability assessment reflect autonomic changes and predict complications in patients undergoing coronary artery bypass grafting?

Population

Patients undergoing coronary artery bypass grafting (CABG) across 26 included studies.

Intervention

Coronary artery bypass grafting (CABG) and heart rate variability (HRV) assessment

Comparator

Pre-operative HRV status or control groups (e.g., healthy subjects, non-surgical patients)

Outcome

Changes in heart rate variability (HRV) parameters after CABG and prediction of post-operative complications including atrial fibrillationsurrogate

HRV decreases acutely after CABG but recovers by 6 months, and non-linear HRV parameters may help identify patients at increased risk for post-operative atrial fibrillation.

Limitations

Methodological discrepancies regarding assessment of HRV across the analyzed studies.
Clinical use of nonlinear measures of HRV for risk assessment needs further confirmation in prospective studies with larger samples.

Abstract

Background: Coronary artery bypass grafting (CABG) is a well-established surgical procedure used to treat significant coronary artery disease. Nevertheless, unfavorable cardiovascular events and complications, including cardiac arrhythmias may be observed in patients after CABG. Previous studies have revealed a relationship between risk of cardiac arrhythmias and abnormal heart rate variability (HRV), which reflects adverse alterations in cardiac autonomic functioning, that may occur in patients after a CABG procedure. The aim of this article was to provide a systematic review of the major research findings in this area. Methods: A literature search was carried out using PubMed, Cochrane, and Embase databases and relevant articles, published in English, were analyzed in detail. Results: Studies performed so far have shown time depending changes in HRV after CABG. Time and frequency domain HRV decrease acutely after CABG but recover almost completely to pre-operative values by 6 months after surgery. Some preoperative clinical states such as: heart failure, type 2 diabetes mellitus and depression adversely affect post-CABG HRV. Finally, post-CABG cardiac rehabilitation appears to improve exercise capacity and speed up recovery of HRV. Conclusions: Generally, traditional time and frequency domain HRV parameters fail to predict complications post-CABG. Altered non-linear measures of HRV may identify subgroups of subjects at increased risk of potential complications, including atrial fibrillation post-CABG. However, data available currently does not appear to unequivocally support the hypothesis that early HRV assessment in post-CABG patients predicts long-term mortality.

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