Open Access

Journal of the American Heart Association, volume 10, issue 4

Maturation of the Cardiac Autonomic Nervous System Activity in Children and Adolescents

Lisette M. Harteveld ¹

Ineke Nederend ^{1, 2}

Arend D.J. ten Harkel ¹

Nienke M. Schutte ²

Susanne R. de Rooij ^{3, 4}

Tanja G.M. Vrijkotte ⁴

Helena Oldenhof ⁵

Arne Popma ⁵

Lucres M. C. Jansen ⁵

Jill Suurland ⁶

Hanna Swaab ⁶

E J de Geus ²

Show full list: 12 authors

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Department of Pediatric Cardiology Leiden University Medical Center Leiden The Netherlands |

Department of Biological Psychology Faculty of Human Behavioral and Movement Sciences Vrije Universiteit AmsterdamAmsterdam Public Health Research Institute Amsterdam The Netherlands |

Department of Clinical Epidemiology, Biostatistics and Bioinformatics Amsterdam University Medical CenterAcademic Medical Center Amsterdam The Netherlands |

⁴

Department of Public Health Amsterdam Public Health Research InstituteAmsterdam University Medical CenterUniversity of Amsterdam Amsterdam The Netherlands

⁵

Department of Child and Adolescent Psychiatry Amsterdam University Medical CenterVU University Medical Centre Amsterdam The Netherlands |

⁶

Department of Clinical Child and Adolescent Studies and Leiden Institute for Brain and Cognition Leiden University Leiden The Netherlands |

Publication type: Journal Article

Publication date: 2021-02-02

Wiley

Journal: Journal of the American Heart Association

scimago Q1

SJR: 2.126

CiteScore: 9.4

Impact factor: 5

ISSN: 20479980

DOI: 10.1161/JAHA.120.017405

Copy DOI

Cardiology and Cardiovascular Medicine

Abstract

Background

Despite the increasing interest in cardiac autonomic nervous activity, the normal development is not fully understood. The main aim was to determine the maturation of different cardiac sympathetic‐(SNS) and parasympathetic nervous system (PNS) activity parameters in healthy patients aged 0.5 to 20 years. A second aim was to determine potential sex differences.

Methods and Results

Five studies covering the 0.5‐ to 20‐year age range provided impedance‐ and electrocardiography recordings from which heart rate, different PNS‐parameters (eg, respiratory sinus arrhythmia) and an SNS‐parameter (pre‐ejection period) were collected. Age trends were computed in the mean values across 12 age‐bins and in the age‐specific variances. Age was associated with changes in mean and variance of all parameters. PNS‐activity followed a cubic trend, with an exponential increase from infancy, a plateau phase during middle childhood, followed by a decrease to adolescence. SNS‐activity showed a more linear trend, with a gradual decrease from infancy to adolescence. Boys had higher SNS‐activity at ages 11 to 15 years, while PNS‐activity was higher at 5 and 11 to 12 years with the plateau level reached earlier in girls. Interindividual variation was high at all ages. Variance was reasonably stable for SNS‐ and the log‐transformed PNS‐parameters.

Conclusions

Cardiac PNS‐ and SNS‐activity in childhood follows different maturational trajectories. Whereas PNS‐activity shows a cubic trend with a plateau phase during middle childhood, SNS‐activity shows a linear decrease from 0.5 to 20 years. Despite the large samples used, clinical use of the sex‐specific centile and percentile normative values is modest in view of the large individual differences, even within narrow age bands.

Found

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