Evidence map›Paper›PMID 41003713›Full record

ArticlePediatric cardiology2026

Impact of Nonlinear Heart Rate Variability in Postoperative Complex Congenital Heart Disease: Insights From Repaired Tetralogy of Fallot and Fontan Palliation.

Azusa Akiya, Ken Takahashi, Kanato Iwahara, Yusuke Akatsuka, Hiroyuki Sato, Keiya Sato, Hirohisa Kago, Sachie Shigemitsu, Hideo Fukunaga, Katsumi Akimoto and 3 more

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Article in Pediatric cardiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

13 authors.

Azusa AkiyaDepartment of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan.
Ken TakahashiDepartment of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan. kentaka@juntendo.ac.jp.
Kanato IwaharaDepartment of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan.
Yusuke AkatsukaDepartment of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan.
Hiroyuki SatoDepartment of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan.
Keiya SatoDepartment of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan.
Hirohisa KagoDepartment of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan.
Sachie ShigemitsuDepartment of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan.
Hideo FukunagaDepartment of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan.
Katsumi AkimotoDepartment of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan.
Masahiko KishiroDepartment of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan.
Keisuke NakanishiDepartment of Cardiovascular Surgery, Juntendo University Faculty of Medicine, Tokyo, Japan.
Hiromichi ShojiDepartment of Pediatrics, Juntendo University Faculty of Medicine, Tokyo, Japan.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Postoperative patients with complex congenital heart disease (CHD), such as those who have undergone Fontan procedures or Tetralogy of Fallot (TOF) repairs, often experience complications, including arrhythmias and heart failure. Heart rate variability (HRV) analysis assesses autonomic function and predicts cardiac outcomes; however, conventional linear methods have limitations, particularly in pediatric populations with variable heart rates. Nonlinear HRV analysis offers a robust alternative. This study evaluated the utility of nonlinear HRV indices to identify early autonomic dysfunction in postoperative patients with CHD. A total of 41 postoperative patients with CHD (22 Fontan, 19 TOF) and 34 age-matched healthy controls underwent 24-h electrocardiogram recordings during sleep. Frequency- and time-domain HRV indices were calculated, alongside nonlinear measures such as Poincaré plot analysis and Higuchi fractal dimension (HFD). Statistical analyses compared the groups and assessed correlations between HRV indices and clinical parameters. Patients who underwent TOF repairs exhibited significantly lower low frequency, high frequency, standard deviation of all normal R-R intervals, and the root mean square of successive differences between R-R intervals values than those in the control group. Nonlinear indices, particularly HFD, were unaffected by heart rate, enhancing reliability in pediatric populations. Age-related declines in fractal indices in postoperative patients with TOF repairs suggest progressive autonomic dysfunction. Nonlinear HRV analysis offers valuable insights into autonomic dysregulation in postoperative patients with CHD, surpassing conventional methods in reliability. These approaches may enable early detection of autonomic deterioration, improving risk stratification and guiding management. Further validation in larger cohorts is warranted.

Indexed as

Autonomic Nervous SystemFontan ProcedureHeart Defects, CongenitalHeart RatePostoperative ComplicationsTetralogy of FallotAdolescentCase-Control StudiesChildChild, PreschoolElectrocardiographyFemaleHumansInfantMalePostoperative PeriodChildrenComplex congenital heart diseaseHeart failureHeart rate variabilityNonlinear analysis

Identifiers

PMID41003713

What Socratic holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.