Heart rate variability and cardiac autonomic function in men with chronic alcohol dependence.

Abstract

Cardiac autonomic function was studied in 23 alcohol dependent men by standard tests of autonomic function and measurement of 24 hour heart rate variability. In all there was peripheral or central nervous system damage or both. Standard tests of autonomic function showed vagal neuropathy in seven. The remainder had normal autonomic function tests. Twenty four hour heart rate variability was measured as the standard deviation of the successive differences between RR intervals from an ambulatory electrocardiogram recording. Twenty four hour heart rate variability was significantly lower in both alcohol dependent groups than in controls, but the results in the two alcohol dependent groups were not significantly different from each other. The results of standard tests of autonomic function did not distinguish between the alcohol dependent men with normal autonomic function and controls. The differences in heart rate variability between this group and the controls may have been the result of the ability of this method to detect small changes in autonomic integrity. Cardiomyopathy may also account for some of these differences and such abnormalities should be excluded before results are to be regarded as a reflection of vagal function. Twenty four hour measurement of heart rate variability may be a more useful index of cardiac vagal neuropathy than currently available tests of autonomic function. activity but this does not take into account that inputs of different frequencies produce the change in heart rate; those at lower frequencies are not necessarily autonomic in origin such as reflex mechanisms involved with continuing haemodynamic changes. Tests of autonomic function also tend to classify patients merely on the basis of the presence of neuropathy and give little scope for grading its severity.5 Measurement of short term (5 min) heart rate variability has been advocated as an indicator of autonomic neuropathy6; however, there is disagreement about whether the recording should be performed with the patient standing, sitting, or lying and about the best index for measuring heart rate variability.7 Ambulatory electrocardiographic (Holter) monitoring of heart rate variability may provide a more sensitive index of autonomic function than is currently available8 because it makes a large number of RR intervals available for the calculation of heart rate variability. Monitoring over 24 hours also provides an opportunity to examine autonomic function during normal daily activities without interference from investigators. It may enable disease progression in alcohol dependent patients to be monitored. Ewing and colleagues reported that heart rate variability was reduced in diabetic patients who had normal standard autonomic function tests.8 The present study was conducted to test whether similar results apply to alcohol dependent patients and whether 24 hour measurement of heart rate variability is a useful method for assessing cardiac autonomic changes in alcohol dependent patients.

Heart Rate Variability: Measurement and Clinical Utility

“…Several authors have reported that HRV analysis is a more sensitive indicator of autonomic dysfunction in alcoholics and in diabetic subjects than conventional autonomic tests. [78][79][80][81] Heart rate variability analysis has also been used to assess the autonomic effects of drugs, including beta-blockers, calcium blockers, antiarrhythmics, psychotropic agents, and cardiac glycosides. [65][66][67][82][83][84][85][86][87][88][89][90][91] Drug effects on HRV can be established with relatively small numbers of study participants because HRV measurements are quite stable over the short-and long-term.…”

Effects of chronic moderate alcohol consumption and novel environment on heart rate variability in primates (Macaca fascicularis)

“…Chronic excessive alcohol use also impairs autonomic function in human subjects as evidenced by decreasing HRV and increasing mean HR (Malpas et al 1991;DePetrillo et al 1999;Ingjaldsson et al 2003). These effects are evident even after a 48-h abstinence in alcoholics (DePetrillo et al 1999).…”

Heart Rate Variability

“…ECG indices of vagal activity have been reported to have significantly lower indices of cardiac vagal nerve activity than normal volunteers, in acute alcoholic subjects [94,96,97].…”

“…Malpas et al have demonstrated vagal neuropathy in men with chronic alcohol dependence using 24 hour HRV analysis [94].…”