Esophageal PP intervals for analysis of short-term heart rate variability in patients with atrioventricular block before and after insertion of a temporary ventricular inhibited pacemaker

Heart rate variability (HRV) analysis is a useful method for assessment of the activities of autonomic nervous system. The RR intervals in ECG is measured for this purpose. However, RR intervals are not suitable for HRV analysis in atrioventricular block (AV) block patients with ventricular inhibited (VVI) pacemaker, as the intervals will be fixed by the ventricular pacemaker. Thus we used an esophageal lead to detect PP intervals for analysis of HRV. The aim of this study was to evaluate the short-term HRV by using an esophageal electrode to detect the atrial signal and PP intervals in AV block patients. Fifteen AV block patients before and after temporary VVI pacemaker and 15 subjects with normal AV conduction (control group) were enrolled in this study. The atrial signals from esophageal lead, ECG and intraatrial lead were recorded. The duration was 10 min. We compared correlation coefficient of PP intervals from different leads in AV block patients and the control group. We also compared the PP interval's variability parameters between the control group and AV block patients, before and after insertion of a temporary ventricular inhibited pacemaker. The esophageal PP intervals were excellently correlated with intraatrial AA intervals (r=0.98±0.01). The HRV using esophageal PP intervals with time domain demonstrated a significant decrease in patients with AV block (standard deviation of all PP intervals (SDNN) (s)=0.022±0.014; percentage difference between adjacent PP intervals that are greater than 50 ms (pNN- 50) (%)=0.052±0.038; square root of the mean of squares of differences between duration of neighboring PP intervals (r-MSDD) (s)=0.322±0.082) but this returned to normal after insertion of a temporary ventricular inhibited pacemaker (SDNN (s)=0.035±0.009; pNN-50 (%)=2.540±1.682; r-MSDD (s)=0.542±0.190). However, the ratio of low frequency/high frequency (LF/HF) still increased (LF/HF=4.120±1.802). The result of this short-term HRV analysis suggested that withdrawal of vagal tone or increased sympathetic activity in AV block patients compared with the control group. This appearance was normalized after insertion of a temporary VVI pacemaker. However, abnormal sympathovagal balance still remained.