Differential Effects of Parasympathetic Blockade and Parasympathetic Withdrawal on Heart Rate Variability

Challapalli, Sridevi; Kadish, Alan H.; Horvath, George; Goldberger, Jeefrey J.

doi:10.1111/j.1540-8167.1999.tb00295.x

Cited by 23 publications

(15 citation statements)

References 32 publications

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“…These variations have already been reported in previous studies and appeared to be logical considering the parasympatholytic effect of this drug [17,18]. We found the diminution of the parameters reflecting parasympathetic activity was not proportional to the reference values.…”

Section: Discussionsupporting

confidence: 57%

Effect of remifentanil with and without atropine on heart rate variability and RR interval in children

et al. 2005

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SummaryRemifentanil can cause bradycardia either by parasympathetic activation or by other negative chronotropic effects. The high frequency (HF) component of heart rate variability (HRV) is a marker of parasympathetic activity. This study aimed to evaluate the effect of remifentanil on RR interval and on HRV in children. Forty children ASA I or II were studied after approval by the human studies committee and informed parental consent was obtained. After stabilisation at sevoflurane 1 MAC, they were randomly divided into two groups: one received a 20 lg.kg atropine injection (AT + REMI) and the other ringer lactate solution (REMI). Three minutes later, a 1 lg.kg )1 bolus of remifentanil was administered over 1 min, followed by a continual infusion at 0.25 lg.kg )1 .min )1 for 10 min increased to 0.5 lg.kg )1 .min )1 for a further 10 min.A time varying, autoregressive analysis of RR sequences was used to estimate classical spectral parameters: low (0.04-0.15 Hz; LF) and high (0.15-0.45 Hz; HF) frequency, whereas the root mean square of successive differences of RR intervals (rmssd) was derived directly from the temporal sequence. Statistical analyses were conducted by means of the multiple correspondence analysis and with non parametrical tests. Remifentanil induced an RR interval lengthening, i.e. bradycardia, in both groups compared to pretreatment values and was associated with an increase of HF and rmssd only for the REMI group. The parasympathetic inhibition by atropine did not totally prevent remifentanil's negative chronotropic effect. A direct negative chronotropic effect of remifentanil is proposed.

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Section: Discussionsupporting

confidence: 57%

Effect of remifentanil with and without atropine on heart rate variability and RR interval in children

et al. 2005

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“…For example, different modes of beta-adrenergic activation (exercise, catecholamine infusion, and upright tilt) result in divergent changes in frequency domain indices which have been reported to reflect sympathetic activity (34). Partial parasympathetic blockade and baroreflex-mediated sympathetic withdrawal to similar degrees (as determined by HR) result in diminished HF power, but to different degrees (46). A 10-fold difference in HF power demonstrated at different respiratory rates between 0.4 and 0.1 Hz (24 to 6 breaths/min) despite similar HR again shows that HF power can vary greatly despite similar levels of parasympathetic effect (47) and underscores the role of modulation of HR as the determinant of HRV.…”

Section: Hrvmentioning

confidence: 97%

Assessment of Autonomic Function in Cardiovascular Disease

Lahiri

Kannankeril

Goldberger

2008

Journal of the American College of Cardiology

477

382

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Certain abnormalities of autonomic function in the setting of structural cardiovascular disease have been associated with an adverse prognosis. Various markers of autonomic activity have received increased attention as methods for identifying patients at risk for sudden death. Both the sympathetic and the parasympathetic limbs can be characterized by tonic levels of activity, which are modulated by, and respond reflexively to, physiological changes. Heart rate provides an index of the net effects of autonomic tone on the sinus node, and carries prognostic significance. Heart rate variability, though related to heart rate, assesses modulation of autonomic control of heart rate and carries additional prognostic information, which in some cases is more powerful than heart rate alone. Heart rate recovery after exercise represents the changes in autonomic tone that occur immediately after cessation of exercise. This index has also been shown to have prognostic significance. Autonomic evaluation during exercise and recovery may be important prognostically, because these are high-risk periods for sudden death, and the autonomic changes that occur with exercise could modulate this high risk. These markers provide related, but not redundant information about different aspects of autonomic effects on the sinus node.

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“…Variations in respiratory frequency or depth of inspiration may also produce variations in RSA magnitude which are not necessarily associated with changes in vagal tone [5,26,30,33]. There are also examples of divergence of HRV from parasympathetic tone in both within-and between-subjects designs, which could be due to a non-monotonic relationship between the two variables [6,15,36]. The sensitivity of the dosedependent response curve to vagal blockade for RSA and HR might differ [36].…”

Section: Introductionmentioning

confidence: 97%

Relationship between pulse interval and respiratory sinus arrhythmia: a time- and frequency-domain analysis of the effects of atropine

Médigue

Girard

Laude

et al. 2001

Pflügers Arch - Eur J Physiol

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Respiratory sinus arrhythmia (RSA) estimation is commonly used as a non-invasive index of cardiac vagal tone. To test this relationship, vagal tone was augmented or blocked using atropine. The study was carried out using 14 healthy volunteers, following beta-adrenoceptor blockade (10 mg bisoprolol per os) and during controlled respiration (0.25 Hz) in order to limit the confounding effects of cardiac sympathetic tone and respiration pattern changes. Atropine was slowly infused intravenously over a 30-min period up to a vagolytic cumulative dose of 0.04 mg/kg. The instant vagal tone was compared to the instant RSA value obtained from a time-/frequency-domain analysis of pulse interval (PI). RSA and PI varied in the same direction with an initial increase corresponding to the early vagomimetic effect of atropine followed by a decrease during the vagolytic phase. The comparative percentage fluctuations of RSA and PI over this large vagal tone range indicate that RSA is more sensitive (about twofold) than PI in reflecting fluctuations around the set point. This dissociated behaviour of PI and heart rate variability could be important to our understanding of the circulatory changes that result from fluctuations in vagal inputs to the sinus node.

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Differential Effects of Parasympathetic Blockade and Parasympathetic Withdrawal on Heart Rate Variability

Cited by 23 publications

References 32 publications

Effect of remifentanil with and without atropine on heart rate variability and RR interval in children

Effect of remifentanil with and without atropine on heart rate variability and RR interval in children

Assessment of Autonomic Function in Cardiovascular Disease

Relationship between pulse interval and respiratory sinus arrhythmia: a time- and frequency-domain analysis of the effects of atropine

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