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Title: Maturation of the Cardiac Autonomic Nervous System Activity in Children and Adolescents
Author(s): L. M. Harteveld, I. Nederend, A. D. Ten Harkel, N. M. Schutte, S. R. de Rooij, T. G. Vrijkotte, ... and E. J. de Geus
Journal: Journal of the American Heart Association
Year: 2021
Volume: 10
Issue: 4
Pages: e017405
DOI: 10.1161/JAHA.120.017405
File URL: /vuams-pubs/JAHA.120.017405.pdf
Keywords: autonomic nervous system ? heart rate variability ? sympathetic nerve activity ? development ? pediatrics
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 (preejection 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 SNSactivity 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.

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