Abstract
This study was undertaken to determine the nature of brady-arrhythmic events and their relationship to motor disability, disease stages and tachycardia in patients with Guillain-Barré syndrome, and to investigate the potential of the 24-hour heart rate power spectrum (HRPS) for the detection of serious bradyarrhythmias in individual patients. Thirty-five consecutive patients with Guillain-Barré syndrome who were admitted to the authors' intensive care unit were studied. In all patients, the heart rate was continuously recorded during the early stages of the disease, averaged at 1-minute intervals, and stored for 1 to 87 days. The HRPS (n=556, 16±19 per patient; median, 9) was calculated by Fourier analysis of 24-hour recordings and logarithmically transformed. The slope was estimated by regression analysis of log (power) on log (frequency) between 10−4 and 4×10−3 Hz, showing an inverse power law behavior in all 556 HRPSs. Eleven patients (31%) had serious bradyarrhythmias. Most of these patients were not dependent on mechanical ventilation, with 3 of 11 patients (27%) still being able to walk more than 5 meters. Sustained tachycardia occurred less frequently in patients with than in those without bradyarrhythmias. The combination of the slope of the power law regression line and the log (power) at 10−4 Hz (log P4) of the 24-hour HRPS correctly identified 8 of 11 bradyarrhythmic patients (sensitivity 73%) and 16 of 22 patients with Guillain-Barré syndrome who did not have bradyarrhythmias (specificity 73%). All bradyarrhythmic patients could be detected in the subgroup of patients without sustained tachycardia. The 24-hour HRPS is a powerful predictor of serious autonomic complications in patients with Guillain-Barré syndrome and may help to identify patients at risk of potentially life-threatening arrhythmias.
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References
Hartung HP, Pollard JD, Harvey GK, Toyka KV. Immunopathogenesis and treatment of the Guillain-Barré syndrome: part I.Muscle Nerve 1995; 18:137–153.
Hartung HP, van der Meche FG, Pollard JD. Guillain-Barré syndrome, CIDP and other chronic immune-mediated neuropathies.Curr Opin Neurol 1988; 11:497–513.
Ropper AH. The Guillain-Barré syndrome.N Engl J Med 1992; 326:1130–1136.
Arnason BG, Soliven B. Acute inflammatory demyelinating polyradiculoneuropathy. In:Peripheral neuropathy. Dyck PJ, Thomas PK, Griffin JW, Low PA, Poduslo JF, eds. Philadelphia: W.B. Saunders; 1993. pp. 1437–1497.
Zochodne DW. Autonomic involvement in Guillain-Barré syndrome: a review.Muscle Nerve 1994; 17:1145–1155.
Raphael JC, Masson C, Morice V, Brunel D, Gajdos P, Barois A, et al. Le syndrome de Landry-Guillain-Barré: étude des facteurs prognostiques dans 223 cas.Rev Neurol Paris 1986; 142:613–624.
Winer JB, Hughes RA. Identification of patients at risk of arrhythmia in the Guillian-Barré syndrome.Q J Med 1988; 68:735–739.
Hughes RA, Bihari D. Acute neuromuscular respiratory paralysis.J Neurol Neurosurg Psychiatry 1993; 56:334–343.
Minahan RE Jr, Bhardwaj A, Traill TA, Hanley DF. Stimulusevoked sinus arrest in severe Guillain-Barré syndrome: a case report.Neurology 1996; 47:1239–1242.
Guidon C, Granthil C, Djiane P, Francois G. Dysautonomie en deux temps au cours d'un syndrome de Guillain-Barré.Ann Fr Anesth Reanim 1986; 5:447–449.
Flachenecker P, Müllges W, Wermuth P, Hartung HP, Reiners K. Eyeball pressure testing in the evaluation of serious bradyarrhythmias in Guillain-Barré syndrome.Neurology 1996; 47:102–108.
Hund EF, Schuchardt V, Ropper AH. Acute inflammatory polyneuropathy (Guillain-Barré syndrome). In:Neurocritical care. Hacke W, ed. Berlin: Springer-Verlag; 1994. pp. 774–787.
Flachenecker P, Reiners K. Twenty-four-hour heart rate power spectrum for evaluation of autonomic dysfunction in Guillain-Barré syndrome.J Neurol Sci 1999; 165:144–153.
Asbury AK, Cornblath DR. Assessment of current diagnostic criteria for Guillain-Barré syndrome.Ann Neurol 1990; 27:S21-S24.
Bigger JT Jr., Steinman RC, Rolnitzky LM, Fleiss JL, Albrecht P, Cohen RJ. Power law behavior of RR-interval variability in healthy middle-aged persons, patients with recent acute myocardial infarction, and patients with heart transplants.Circulation 1996; 93: 2142–2151.
Meesmann M, Schmidt G. Technical advances in heart rate variability processing.Cardiac Electrophys Rev 1997; 1:338–342.
Guillain-Barré Syndrome Steroid Trial Group. Double-blind trial of intravenous methylprednisolone in Guillian-Barré syndrome.Lancet 1993; 341:586–590.
Ropper AH, Wijdicks EFM, Truax BT.Guillain-Barré syndrome. Philadelphia: F.A. Davis; 1991.
Truax BT. Autonomic disturbances in the Guillain-Barré syndrome.Semin Neurol 1984; 4:462–468.
Singh NK, Jaiswal AK, Misra S, Srivastava PK. Assessment of autonomic dysfunction in Guillain-Barré syndrome and its prognostic implications.Acta Neurol Scand 1987; 75:101–105.
Flachenecker P, Wermuth P, Hartung HP, Reiners K. Quantitative assessment of cardiovascular autonomic function in Guillain-Barré syndrome.Ann Neurol 1997; 42:171–179.
de Jager AE, Sluiter HJ. Clinical signs in severe Guillain-Barré syndrome: analysis of 63 patients.J Neurol Sci 1991; 104:143–150.
Ropper AH. Intensive care of acute Guillain-Barré syndrome.Can J Neurol Sci 1994; 21:S23-S27.
French Cooperative Group on Plasma Exchange in Guillain-Barré Syndrome. Efficiency of plasma exchange in Guillain-Barré syndrome: role of replacement fluids.Ann Neurol 1987; 22:761.
Rees JH, Thompson RD, Smeeton NC, Hughes RA. Epidemiological study of Guillain-Barré syndrome in south east England.J Neurol Neurosurg Psychiatry 1998; 64:74–77.
Lawn ND, Wijdicks EFM. Fatal Guillain-Barré syndrome.Neurology 1999; 52:635–638.
Winer JB, Hughes RAC, Osmond C. A prospective study of acute idiopathic neuropathy. I. Clinical features and their prognostic value.J Neurol Neurosurg Psychiatry 1988; 51:605–612.
The Italian Guillain-Barré Syndrome Study Group. The prognosis and main prognostic indicators of Guillain-Barré syndrome: a multicentre prospective study of 297 patients.Brain 1996; 119:2053–2061.
Kobayashi M, Musha T. 1/f fluctuation of heartbeat period.IEEE Trans Biomed Eng 1982; 29:456–457.
Saul JP, Albrecht P, Berger RD, Cohen RJ. Analysis of long term heart rate variability: methods, 1/f scaling and implications.Comput Cardiol 1988; 14:419–422.
Huikuri HV, Makikallio TH, Airaksinen KE, Seppanen T, Puukka P, Raiha IJ, et al. Power-law relationship of heart rate variability as a predictor of mortality in the elderly.Circulation 1998; 97:2031–2036.
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Flachenecker, P., Lem, K., Müllges, W. et al. Detection of serious bradyarrhythmias in Guillain-Barré syndrome: Sensitivity and specificity of the 24-hour heart rate power spectrum. Clinical Autonomic Research 10, 185–191 (2000). https://doi.org/10.1007/BF02291354
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DOI: https://doi.org/10.1007/BF02291354