Hemodynamics and Autonomic Control of Heart Rate Turbulence

Wichterle, Dan; Melenovský, Vojtěch; Simek, J; Malík, Jan; Malík, Marek

doi:10.1111/j.1540-8167.2005.00330.x

Cited by 40 publications

(36 citation statements)

References 33 publications

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“…Frequent and persistent exposure to PVCs is associated with complex transient alterations in intracellular calcium and membrane ionic currents, heart rate dynamics, hemodynamic parameters, and both myocardial and peripheral vascular autonomic stimulation and inhibition. [35][36][37][38] Morphological and functional abnormalities of the ventricular myocardium and outflow tracts may be found on MRI in patients with apparently idiopathic PVCs, albeit this does not necessarily have a clinical implication. Bogun et al 15 postulated that ventricular dyssynchrony and increased oxygen consumption may be possible patho- Figure 1.…”

Section: Mechanisms and Pathophysiologymentioning

confidence: 99%

Premature Ventricular Contraction-Induced Cardiomyopathy

Mei

Lee

Klarich

et al. 2012

Circ: Arrhythmia and Electrophysiology

175

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Section: Mechanisms and Pathophysiologymentioning

confidence: 99%

Premature Ventricular Contraction-Induced Cardiomyopathy

Mei

Lee

Klarich

et al. 2012

Circ: Arrhythmia and Electrophysiology

175

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“…Numerous studies investigated the relationship between baroreflex and HRT phenomenon [5,7,9,13,14,24]. Although the degree of correlation varied with the different baroreflex techniques, all of these studies confirmed the relationship.…”

Section: Discussionmentioning

confidence: 58%

“…They documented good correlation between HRT-and BRS parameters. In a recent report, Wichterle et al [24] calculated baroreflex gain from the five post-extrasystolic cycles, which also served for TS calculations. This gain showed good correlation not only with the TS, but also with another spontaneous baroreflex index, the transfer function modulus in the low frequency (0.05-0.15 Hz) band.…”

Section: Discussionmentioning

confidence: 99%

Spontaneous baroreflex sensitivity and heart rate turbulence parameters: parallel responses to orthostasis

et al. 2008

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Premature ventricular contractions (PVC-s) induce baroreflex mediated arterial pressure and heart rate fluctuations. PVC-related RR interval fluctuations detected on Holter ECG recordings could be characterized by the heart rate turbulence (HRT) parameters, including early post-extrasystolic acceleration, described by turbulence onset, and late deceleration, described by turbulence slope (TS). We have determined the increasing and decreasing spontaneous baroreflex sequence sensitivity (up- and down-BRS) parameters in supine and in upright position in 12 patients with VVI pacemaker while in sinus rhythm. Five-five premature ventricular pacemaker extrastmuli were also applied in both body positions and HRT parameters were calculated. Up- and down-BRS values showed a very close relationship with TS both in the supine (R = 0.94, P < 0.001 and R = 0.92, P < 0.001, respectively), and upright position (R = 0.96, P < 0.001, and R = 0.94, P < 0.001, respectively). The BRS indices decreased significantly upon tilting, which was paralleled by a significant decrease in TS (from 21.6 to 13.9 ms/cycle, P = 0.02). Our findings confirm the close association between TS and spontaneous BRS indices. The relationship is further supported by the similar postural behavior of these parameters. Our results suggest that the confounding effect of posture should be considered when analyzing Holter recordings.

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“…TO denotes the acceleration of sinus rate immediately after a ventricular premature beat and is known to be due to vagal withdrawal (26). Delayed sympathetically mediated vasomotor response to the initial loss of cardiac output after ventricular extrasystole produces systolic blood pressure overshoot that subsequently induces vagally mediated late heart rate deceleration.…”

Section: Discussionmentioning

confidence: 99%

The effects of cardiac resynchronization treatment on autonomic functions aside from functional status in heart failure

Arslan¹,

Balcı²,

Kocaoğlu³

et al. 2013

Anadolu Kardiyol Derg

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Objective: Cardiac resynchronization therapy (CRT) improves heart rate variability (HRV) and heart rate turbulence (HRT) parameters. Herein, our aim was to compare these parameters with intracardiac-cardioverter defibrillator (ICD) patients with similar functional status to detect possible additional benefits of CRT on autonomic functions. Methods: Patients who had systolic HF (NYHA class II and III) with an ejection fraction <35% were enrolled in this observational, cross-sectional study. These patients were implanted either an ICD or a CRT device. A 24-hour Holter recording was obtained to assess HRV and HRT parameters in 2 groups. Unpaired t-test and Chi-square test were used for comparisons between 2 groups. Logistic regression analysis was performed to determine the variables affecting functional status. Results: Of 105 patients included in the study; 55 had CRT and 50 had ICD device. The baseline characteristics of the patients were similar in both groups. SDNN, SDANN, SDNN index, and LFnu were similar in both groups; however, RMSSD, pNN50, HFnu, LF/HF ratio, turbulence slope and albeit to a non-significant value turbulence onset were better in CRT group. When the HRV and HRT parameters were compared according to functional status, patients in functional class II had significantly better HRV and HRT parameters when compared to the ones in class III (p<0.05 for all). Regression analysis showed that only SDNN was associated with functional class [OR: 0.89 (95% CI: 0.80-0.98), p=0.03]. After the covariance analysis to eliminate the effects of functional status on HRV and HRT parameters; the parameters mostly related with the parasympathetic system activity, namely RMSSD, pNN50, HFnu, LF/HF ratio, turbulence onset and turbulence slope were still better in CRT group. Conclusion: The most striking finding in our study is that HRV and HRT values related with parasympathetic activation are better in CRT patients when compared to ICD patients with similar functional status. Therefore, upgrading to CRT may have additional benefits on autonomic functions, which needs further investigation. (Anadolu Kardiyol Derg 2013; 13: 439-45) Key words: Heart failure, heart rate variability, heart rate turbulence, cardiac resynchronization therapy, functional status, regression analysis Original Investigation Özgün Araşt›rma 439ÖZET Amaç: Kardiyak resenkronizasyon tedavisinin (KRT) kalp yetersizliği (KY) hastalarında kalp hızı değişkenliği (KHD) ve kalp hızı türbülansını (KHT) düzeltti-ği bilinmektedir. Bu çalışmada amacımız KRT'nin fonksiyonel kapasiteyi düzelterek oluşturduğu KHD ve KHT düzelmesinin üzerine olası ek faydasını incelemektir. Bu amaçla intrakardiyak kardioverter defibrilatörü (İKD) olan KY hastalarındaki KHD ve KHT parametrelerini KRT'li hastalarla karşılaştırdık.Yöntemler: Ejeksiyon fraksiyonu <%35 olan sistolik kalp yetmezlikli (NYHA sınıf 2-3) hastalar bu gözlemsel ve kesitsel çalışmaya dahil edildi. Bu hastalara İKD veya KRT cihazı implante edilmişti. Yirmi dört saatlik Holter EKG kayıtlarından KHD ve ...

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Hemodynamics and Autonomic Control of Heart Rate Turbulence

Cited by 40 publications

References 33 publications

Premature Ventricular Contraction-Induced Cardiomyopathy

Premature Ventricular Contraction-Induced Cardiomyopathy

Spontaneous baroreflex sensitivity and heart rate turbulence parameters: parallel responses to orthostasis

The effects of cardiac resynchronization treatment on autonomic functions aside from functional status in heart failure

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