Effect of Atropine on the Qt Interval and T-Wave Amplitude in Healthy Volunteers

Annila, P.; Yli‐Hankala, Arvi; Lindgren, L.

doi:10.1093/bja/71.5.736

Cited by 46 publications

(32 citation statements)

References 6 publications

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“…Our previous studies support this, showing the correlation between EEG transients and heart rate [20], as well as the reversed phase relationship of RSA during positive pressure ventilation [15]. Anticholinergics do not abolish RSA during anaesthesia and mechanical ventilation [21], although this is the case during spontaneous breathing [22,23]. The resistance to anticholinergics, together with the reversed phase relationship, suggests that the control mechanisms of RSA during positive pressure ventilation differ from thQse during spontaneous breathing while awake.…”

Section: Discussionsupporting

confidence: 61%

Respiratory sinus arrhythmia during anaesthesia: assessment of respiration related beat-to-beat heart rate variability analysis methods

Loula

Jäntti

Yli‐Hankala

1997

Int. J. Clin. Mon. Comp.

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Beat-to-beat heart rate variability analysis is a powerful tool for the diagnosis of neuropathy. Respiration-related heart rate variability (respiratory sinus arrhythmia, RSA) reflects the function of parasympathetic nervous system during spontaneous ventilation while awake. RSA is also claimed to monitor the depth of anaesthesia. Power spectrum analysis or various averaging techniques of the heart rate variability are usually applied. The current literature, however, does not usually interpret the ground rules and limitations of the method used, and this may sometimes lead to erroneous conclusions on the data. The aim of our study was to compare and analyse critically the performance of different methods of evaluating RSA during anaesthesia and positive pressure ventilation. Power spectrum analysis, the root mean square of the successive RR-interval difference (RMSSD), and two respiration related methods, RSA index and average phase RSA, were included in the comparison. To test these methods, 11 patients were anaesthetised with isoflurane and their lungs were ventilated mechanically with a frequency of 6 cycles min-1. Each patient received a bolus dose of atropine (20 micrograms kg-1) during the trial. Electrocardiogram, electroencephalogram and tracheal pressure signal from respirator were recorded and analyses were performed off-line. We demonstrated that general indices, such as RMSSD, may be strongly affected by heart rate level and other non-respiration related variations in heart rate. We also showed that the effect of unwanted fluctuations on RSA can be reduced with respiration dependent beat-to-beat methods. Furthermore we confirmed that in addition to the amplitude, also the pattern of respiratory sinus arrhythmia is of interest: the pattern is reversed in phase compared to spontaneous breathing while awake, as we have shown earlier. To analyse RSA during anaesthesia, we recommend the use of an average phase RSA method based on beat-to-beat variability that shows both the amplitude and pattern of RSA. Finally, no measure of RSA should be used without a presentation of the actual beat-to-beat heart rate curve.

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Section: Discussionsupporting

confidence: 61%

Respiratory sinus arrhythmia during anaesthesia: assessment of respiration related beat-to-beat heart rate variability analysis methods

Loula

Jäntti

Yli‐Hankala

1997

Int. J. Clin. Mon. Comp.

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“…Über die Wir kung von Atropin lie gen un ter schied li che An ga ben vor, zum einen als Trig ger von TdPs bei ei nem an ge bo re nen LQTS [12], zum an de ren als er folg rei che The ra pie bra dy kar di eindu zier ter TdPs ei nes er wor be nen LQTS [102]. An herz ge sun den Pro ban den ver län-gert Atro pin die QT c [4]. Sym pa thi ko mime ti ka kön nen beim er wor be nen LQTS und theo re tisch beim LQTS3 an ge wen det wer den, aber u. U. eben falls ar rhyth mogen wir ken.…”

Section: Akut Be Hand Lung Der Tor Sa Des De Poin Tesunclassified

Das Long-QT-Syndrom in der Anästhesie

2006

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The long QT syndrome (LQTS) is a rare, congenital or acquired disease, which may lead to fatal cardiac arrhythmias (torsade de pointes, TdP). In all LQTS subtypes, TdPs are caused by disturbances in cardiac ion channels. Diagnosis is made using clinical, anamnestic and electrocardiographic data. Triggers of TdPs are numerous and should be avoided perioperatively. Sufficient sedation and preoperative correction of electrolyte imbalances are essential. Volatile anaesthetics and antagonists of muscle relaxants should be avoided and high doses of local anaesthetics are not recommended to date. Propofol is safe for anaesthesia induction and maintenance. The acute therapy of TdPs with cardiovascular depression should be performed in accordance with the guidelines for advanced cardiac life support and includes cardioversion/defibrillation and magnesium. Torsades de pointes may be associated with bradycardia or tachycardia resulting in specific therapeutic and prophylactic measures.

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“…Decreases in vagal activity could also directly contribute to a decrease in TWA (Schwartz & Weiss, 1983;Weiss, Del, Reichek, & Engelman, 1980). Dauchot and Gravenstein (1971) and Annila, Yli-Hankala, and Lindgren (1993) indeed found that an acetylcholinergic antagonist (atropine) led to a decrease in the TWA. Contrada et al (1989Contrada et al ( , 1991 further reported a sudden paradoxical TWA increase during very high doses of isoproterenol infusion and reasoned that (baroreflex-induced) increases in vagal activity might have caused the increase in the TWA.…”

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confidence: 92%

Ambulatory measurement of the ECG T‐wave amplitude

et al. 2014

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Ambulatory recording of the preejection period (PEP) can be used to measure changes in cardiac sympathetic nervous system (SNS) activity under naturalistic conditions. Here, we test the ECG T-wave amplitude (TWA) as an alternative measure, using 24-h ambulatory monitoring of PEP and TWA in a sample of 564 healthy adults. The TWA showed a decrease in response to mental stress and a monotonic decrease from nighttime sleep to daytime sitting and more physically active behaviors. Within-participant changes in TWA were correlated with changes in the PEP across the standardized stressors (r 5 .42) and the unstandardized naturalistic conditions (mean r 5 .35). Partialling out changes in heart rate and vagal effects attenuated these correlations, but they remained significant. Ambulatory TWA cannot replace PEP, but simultaneous recording of TWA and PEP provides a more comprehensive picture of changes in cardiac SNS activity in real-life settings.

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Effect of Atropine on the Qt Interval and T-Wave Amplitude in Healthy Volunteers

Cited by 46 publications

References 6 publications

Respiratory sinus arrhythmia during anaesthesia: assessment of respiration related beat-to-beat heart rate variability analysis methods

Respiratory sinus arrhythmia during anaesthesia: assessment of respiration related beat-to-beat heart rate variability analysis methods

Das Long-QT-Syndrom in der Anästhesie

Ambulatory measurement of the ECG T‐wave amplitude

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