Spectral analysis of heart rate variability following human heart transplantation: evidence for functional reinnervation

To determine the status of innervation in long-term human donor allografts, the power spectrum of heart rate variability was analysed in 9 post-transplant patients and 7 healthy control subjects. The mean post-transplant follow-up was 17.8 months (range: 2-37 months). Continuous ECG signals were recorded throughout a 15-min rest period. An R-R interval tachogram was generated and an autoregressive model using linear predictive coding, was applied to the heart rate variability data. In 8 transplant patients the frequency oscillations were irregular, broad based and widely dispersed from 0 to 1 Hz. The patterns resembled white noise and were consistent with dissociation of the donor allograft from the recipient's central nervous system. In contrast, one patient displayed a heart rate variability spectrum indistinguishable from that of control subjects. This pattern contained two distinct spectral bands; one corresponding to the patient's respiratory rate at 0.2 Hz and a low frequency Mayer wave at 0.1 Hz. Atropine abolished the respiratory (vagal) peak. Except for this patient's post-transplant time (33 months compared to the group mean of 17.6 months), there were no clinical characteristics which distinguished this patient from the others. While the mean heart rate for the remaining 8 allografts was significantly higher than controls (95.3 vs 64.5 bt/min; P less than 0.001) the standard deviation of heart rate variability for the 8 patients was significantly narrower than controls (0.7 vs 4.86; P less than 0.01). The variance of heart rate for the patient with the normal power spectrum was fourfold greater than the mean SD of the other transplant patients.(ABSTRACT TRUNCATED AT 250 WORDS)