Heart rate variability: a sensitive parameter for detecting abnormal cardiocirculatory changes during a stressful dental procedure.
BACKGROUND
The authors conducted a study to evaluate the sensitivity of heart rate variability, or HRV, in quantifying the cardiocirculatory reaction to dental stress compared with other clinical parameters more frequently used in clinical practice.


METHODS
Twenty-five healthy subjects (15 men and 10 women aged 19 through 73 years) who underwent dental extractions were enrolled in the study. The authors measured systolic blood pressure, or SBP; diastolic blood pressure, or DBP; heart rate, or HR; and HRV at baseline, immediately after local anesthetic was administered, during the dental extraction and five minutes after the dental extraction. Time domain measures of HRV were based on interbeat intervals and were obtained by using standard deviations of the R-R intervals, which were calculated during a five-minute period in a continuous electrocardiographic record.


RESULTS
Analysis of variance for repeated measures showed no time-related difference between the four study periods with regard to SBP and DBP. However, HR values were significantly different in three of the four periods, and HRV values were significantly different in all four testing periods. Furthermore, HRV values exhibited greater variability in the maximum changes recorded during dental extractions compared with HR values (0 to 80 milliseconds versus 0 to 31 beats/minute, respectively).


CONCLUSIONS
HRV is a highly sensitive parameter for quantifying the sympathetic drive to the heart during a cardiovascular reaction to a dental operation.


CONCLUSIONS
Clinicians may find that HRV evaluation is useful in monitoring patients with heart disease to detect early signs of cardiac impairment related to local, high sympathetic activity and to prevent cardiovascular emergencies.
Montebugnoli
Lucio
L
Department of Oral Science, University of Bologna, Italy. montebu@alma.unibo.it
Servidio
Dora
D
Miaton
Romina Andrea
RA
Prati
Carlo
C
D000328:Adult; D000368:Aged; D000779:Anesthetics, Local / Q000008:administration & dosage; D001794:Blood Pressure / Q000502:physiology; D003971:Diastole; D004562:Electrocardiography; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006801:Humans; D016014:Linear Models; D008297:Male; D008619:Mepivacaine / Q000008:administration & dosage; D008875:Middle Aged; D013312:Stress, Physiological / Q000503:physiopathology; D013564:Sympathetic Nervous System / Q000503:physiopathology; D013599:Systole; D013997:Time Factors; D014081:Tooth Extraction
D000779:Anesthetics, Local; D008619:Mepivacaine