Evaluation of cardiac autonomic modulation using symbolic dynamics after cardiac transplantation

Sílvia Cristina Garcia de Moura-Tonello, Vitor Oliveira Carvalho, Moacir Fernandes de Godoy, Alberto Porta, Ângela Merice de Oliveira Leal, Edimar Alcides Bocchi, Aparecida Maria Catai

Research output: Contribution to journalArticlepeer-review


Objective: To characterize the behavior of cardiac autonomic modulation in individuals with different times after orthotopic heart transplantation (HTx) using symbolic dynamics analysis. Methods: Sixty patients were evaluated after HTx. We recorded their instantaneous R–R intervals (RRi) by cardiac monitor Polar® RS800CX™ (Polar Electro Oy, Kempele, Finland) for 10 minutes. The same sequence of RRi with 256 consecutive beats was used to perform spectral analysis and symbolic dynamics analysis. We used hierarchical clustering to form groups. One-way analysis of variance (ANOVA) (with Holm-Sidak method) or one-way Kruskal-Wallis test (with Dunn´s post-hoc test) was used to analyze the difference between groups. Linear correlation analysis between variables was performed using Pearson’s or Spearman’s tests. P-value < 0.05 was considered statistically significant. Results: The 0V% index increased, the 2UV% index and the normalized complexity index decreased with an increase of HTx postoperative time. There were a negative correlation between complexity indexes and 0V% and a positive correlation between complexity indexes and 2UV%. Conclusion: Symbolic dynamics indexes were able to show a specific cardiac autonomic modulation pattern for HTx recipients with different postoperative times.

Original languageEnglish
Pages (from-to)572-580
Number of pages9
JournalBrazilian Journal of Cardiovascular Surgery
Issue number5
Publication statusPublished - Jan 1 2019


  • Autonomic Nervous System
  • Heart Rate Variability
  • Heart Transplantation
  • Nonlinear Dynamics

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine


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