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01-02-2004

Effect of Imipramine on Linear and Nonlinear Measures of Heart Rate Variability in Children

Authors: K. Srinivasan, M. V. Ashok, M. Vaz, V. K. Yeragani

Published in: Pediatric Cardiology | Issue 1/2004

Abstract

We investigated the effects of treatment with the tricyclic antidepressant (TCA) imipramine in eight children in supine and standing postures. We used 256 seconds of real-time data for the analyses. Spectral analysis showed a significant decrease of high-frequency (HF) power (0.15–0.5 Hz), especially in the standing posture. Low frequency (LF) HF ratios were significantly higher in the standing posture after treatment, suggesting increased sympathovagal interaction. We also obtained the nonlinear measures of fractal dimension (FD), and approximate entropy (APEN). Although the FD of heart rate was significantly lower in the standing posture, APEN was significantly decreased after treatment in either posture and was the most sensitive measure in this study. These findings suggest a decreased cardiac vagal function with a relative increase in sympathetic responsiveness, which may in part be related to the cardiotoxicity of these drugs. These findings are discussed in relation to the cardiovascular side effects of TCAs.

Akselrod, S, Gordon, D, Ubel, FA, Shannon, DC, Barger, AC, Cohen, RJ 1981Power spectrum analysis of heart rate fluctuation: a quantitative probe of beat-to-beat cardiovascular control.Science213220222PubMed

Allen, AJ, Leonard, H, Swedo, SE 1995Current knowledge of medications for the treatment of childhood anxiety disorders.J Am Acad Child Adolesc Psychiatr34976986CrossRef

Bernstein, GA, Borchardt, CM 1991Anxiety disorders of childhood and adolescence: a critical review.J Am Acad Child Adolesc Psychiatr30519532

Biederman, J 1991Sudden death in children treated with a tricyclic antidepressant.J Am Acad Child Adolesc Psychiatr30495498

Biederman, J, Thisted, RA, Greenhill, LL, Ryan, ND 1995Estimation of the association between desimipramine and the risk for sudden death in 5- to 14-year-old children.J Clin Psychiatr568793

Bigger, JT, Kleiger, RE, Fleiss, JL, Rolnitzky, LM, Steinman, RC, Miller, JP 1988Components of HR variability measured during healing of acute myocardial infarction.Am J Cardiol61208215PubMed

Costello, EJ 1989Developments in child psychiatric epidemiology.J Am Acad Child Adolesc Psychiatr28836841

Eckberg, DL 1997Sympathovagal balance: a critical appraisal.Circulation9632243232PubMed

Furlan, R, Guzzetti, S, Crivellaro, W, et al. 1990Continuous 24-hour assessment of the neural regulation of systemic arterial pressure and RR variabilities in ambulant subjects.Circulation81537547PubMed

Geller, B 1991Commentary on unexplained deaths of children on Norpramin.J Am Acad Child Adolesc Psychiatr30682684

Geller, B, Cooper, TB, Graham, DL, Fetner, HH, Marsteller, FA, Wells, JM 1992Pharmacokinetically designed double-blind placebo-controlled study of nortryptiline in 6- to 12-year-olds with major depressive disorder.J Am Acad Child Adolesc Psychiatr313444

Gordon, D, Herrera, VL, McAlpine, L, et al. 1988Heart rate spectral analysis: a noninvasive probe of cardiovascular regulation in critically ill children with heart disease.Pediatr Cardiol96977PubMed

Johnson, A, Giuffre, RM, O’Malley, K 1996ECG changes in pediatric patients on tricyclic antidepressants, desimipramine and imipramine.Can J Psychiatr41102106

Katz, MJ 1988Fractals and the analysis of waveforms.Comput Biol Med18145156PubMed

Kingwell, BA, Thompson, JM, Kaye, DM, McPherson, GA, Jennings, GL, Esler, MD 1994Heart rate spectral analysis, cardiac norepinephrine spillover, and muscle sympathetic nerve activity during human sympathetic nervous activation and failure.Circulation90234240PubMed

Kleiger, RE, Miller, JP, Bigger, JT, Moss, AJ 1987Decreased heart rate variability and its association with increased mortality after acute myocardial infarction.Am J Cardiol59256262PubMed

Lombardi, F, Sandrone, G, Pernpruner, S, et al. 1987Heart rate variability as an index of sympathovagal interaction after acute myocardial infarction.Am J Cardiol6012391245PubMed

Mezzacappa, E, Steingard, R, Kindlon, D, Saul, P, Earls, F 1998Tricyclic antidepressants and cardiac autonomic control in children and adolescents.J Am Acad Child Adolesc Psychiatr375259CrossRef

Mezzacappa, E, Tremblay, RE, Kindlon, D, et al. 1997Anxiety, antisocial behavior, and heart rate regulation in adolescent males.J Child Psychol Psychiatr38457469

Monk, C, Kovelenko, P, Ellman, LM, et al. 2001Enhanced stress reactivity in pediatric anxiety disorders: implications for future cardiovascular health.Int J Neuropsychopharmacol4199206CrossRefPubMed

Pagani, M, Lombardi, F, Guzzetti, S, et al. 1986Power spectral analysis of heart rate and arterial pressure variabilities as a marker of sympathovagal interaction in man and conscious dog.Circ Res59178193PubMed

Pincus, SM (2002) “Irregularity and asynchrony in biologic network signals.” In: Numerical Computer Methods: Methods in Enzymology Part C, Johnson, ML, Brand, L (Eds.). Academic Press, San Diego. 321: 149–182

Rapaport, JL, Mikkelsen, EJ, Zavadil, A, et al. 1980Childhood enuresis, II: Psychopathology, tricyclic concentration in plasma, and antienuretic effect.Arch Gen Psychiatr3711461152PubMed

Riddle, M, Geller, B, Ryan, N 1993Another sudden death in a child treated with desimipramine.J Am Acad Child Adolesc Psychiatr32792797

Riddle, MA, Nelson, JC, Kleinman, CS, et al. 1991Sudden death in children receiving Norpramin: a review of three reported cases and commentary.J Am Acad Child Adolesc Psychiatr30104108

Shannon, M, Berde, CB 1989Pharmacologic management of pain in children and adolescents.Pediatr Clin North Am36855871PubMed

Singer, HV, Brown, J, Quasky, S, Rosenberg, LA, Melliots, ED, Denckla, M 1995The treatment of attention-deficit hyperactivity disorder in Tourette’s syndrome: a double blind placebo controlled study with clonidine and desimipramine.Pediatrics957481PubMed

Spencer, T, Biederman, J, Wilens, T, Harding, M, O’Donnell, D, Griffin, S 1996Pharmacotherapy of attention-deficit hyperactivity disorder across the life cycle.J Am Acad Child Adolesc Psychiatr35409432PubMed

Srinivasan, K, Ashok, MV, Vaz, M, Yeragani, VK 2002Decreased chaos of heart rate time series in children of patients with panic disorder.Depression Anxiety15159167CrossRef

Srinivasan, K, Sucharita, S, Vaz, M 2002Effect of standing on short-term heart rate variability across age.Clin Physiol Func 1m22404408CrossRef

Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology1996Heart rate variability. Standards of measurement, physiological interpretation, and clinical use.Circulation9310431065PubMed

Vaz, M, Turner, A, Kingwell, B, et al. 1995Postprandial sympatho-adrenal activity: its relation to metabolic and cardiovascular events and to changes in meal frequency.Clin Sci85349357

Walsh, BT, Giardina, EGV, Sloan, RP, Greenhill, L, Goldfein, J 1994Effects of desimipramine on autonomic control of the heart.J Am Acad Child Adolesc Psychiatr33191197

Wilens, TE, Biederman, J, Baldessarini, RJ, et al. 1996Cardiovascular effects of therapeutic doses of tricyclic antidepressants in children and adolescents.J Am Acad Child Adolesc Psychiatr3514911501CrossRef

Yeragani, VK, Pohl, R, Berger, R, Balon, R, Srinivasan, K 1994Relationship between age and heart rate variability in supine and standing postures: a study of spectral analysis of heart rate.Pediatr Cardiol151420PubMed

Yeragani, VK, Srinivasan, K, Balon, R, Ramesh, C, Berchou, R 1994Lactate sensitivity and cardiac cholinergic function in panic disorder.Am J Psychiatr15112261228PubMed

Yeragani, VK, Pohl, R, Balon, R, et al. 1992Effect of imipramine treatment on heart rate variability measures.Neuropsychobiology262732PubMed

Yeragani, VK, Pohl, R, Berger, R, et al. 1993Decreased heart rate variability in panic disorder patients: a study of power spectral analysis of heart rate.Psychiatr Res4689103CrossRef

Yeragani, VK, Pohl, R, Jampala, VC, Balon, R, Ramesh, C, Srinivasan, K 2000Increased QT variability in patients with panic disorder and depression.Psychiatr Res93225235CrossRef

Yeragani, VK, Pohl, R, Jampala, VC, Balon, R, Ramesh, C, Srinivasan, K 2000Effects of nortriptyline and paroxetine on QT variability in patients with panic disorder.Depression Anxiety11126130CrossRef

Yeragani, VK, Sobolewski, E, Kay, J, Jampala, VC, Igel, G 1997Effect of age on long-term heart rate variability.Cardiovasc Res353542CrossRefPubMed

Yeragani, VK, Sobolewski, E, Jampala, VC, Kay, J, Yeragani, S, Igel, G 1998Fractal dimension and approximate entropy of heart period and heart rate: awake vs sleep differences and methodological issues.Clin Sci (Colch)95295301CrossRef

Yeragani, VK, Srinivasan, K, Vempati, S, Pohl, R, Balon, R 1993Fractal dimension of heart rate time series: an effective measure of autonomic function.J Appl Physiol7524292438PubMed

Title: Effect of Imipramine on Linear and Nonlinear Measures of Heart Rate Variability in Children
Authors: K. Srinivasan
M. V. Ashok
M. Vaz
V. K. Yeragani
Publication date: 01-02-2004
Publisher: Springer-Verlag
Published in: Pediatric Cardiology / Issue 1/2004
Print ISSN: 0172-0643
Electronic ISSN: 1432-1971
DOI: https://doi.org/10.1007/s00246-003-0468-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Effect of Imipramine on Linear and Nonlinear Measures of Heart Rate Variability in Children

Abstract

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

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