A135 SINUS NODE DYSFUNCTION AND HEART RATE VARIABILITY DURING ISOFLURANE AND DESFLURANE

1997 ◽  
Vol 87 (Supplement) ◽  
pp. 135A
Author(s):  
N. Nathan ◽  
J.P. Frat ◽  
M. Benrhaiem ◽  
P. Blanc ◽  
P. Feiss
2019 ◽  
Vol 40 (4) ◽  
pp. 685-693 ◽  
Author(s):  
Jenny Alenius Dahlqvist ◽  
Urban Wiklund ◽  
Marcus Karlsson ◽  
Katarina Hanséus ◽  
Eva Strömvall-Larsson ◽  
...  

2002 ◽  
Vol 282 (2) ◽  
pp. H445-H456 ◽  
Author(s):  
Josef Gehrmann ◽  
Michael Meister ◽  
Colin T. Maguire ◽  
Donna C. Martins ◽  
Peter E. Hammer ◽  
...  

Acetylcholine released on parasympathetic stimulation slows heart rate through activation of muscarinic receptors on the sinus nodal cells and subsequent opening of the atrial muscarinic potassium channel (KACh). KACh is directly activated by G protein βγ-subunits. To elucidate the physiological role of Gβγ for the regulation of heart rate and electrophysiological function in vivo, we created transgenic mice with a reduced amount of membrane-bound Gβ protein by overexpressing nonprenylated Gγ2-subunits in their hearts using the α-myosin heavy chain promoter. At baseline and after muscarinic stimulation with carbachol, heart rate and heart rate variability were determined with electrocardiogram telemetry in conscious mice and in vivo intracardiac electrophysiological studies in anesthetized mice. Reduction of the amount of functional Gβγ protein by >50% caused a pronounced blunting of the carbachol-induced bradycardia as well as the increases in time- and frequency-domain indexes of heart rate variability and baroreflex sensitivity that were observed in wild types. In addition, sinus node recovery time and inducibility of atrial arrhythmias were reduced in transgenic mice. Our data demonstrate in vivo that Gβγ plays a crucial role for parasympathetic heart rate control, sinus node automaticity, and atrial arrhythmia vulnerability.


2019 ◽  
Vol 21 (2) ◽  
pp. 148-157 ◽  
Author(s):  
Brian W Johnston ◽  
Richard Barrett-Jolley ◽  
Anton Krige ◽  
Ingeborg D Welters

Variation in the time interval between consecutive R wave peaks of the QRS complex has long been recognised. Measurement of this RR interval is used to derive heart rate variability. Heart rate variability is thought to reflect modulation of automaticity of the sinus node by the sympathetic and parasympathetic components of the autonomic nervous system. The clinical application of heart rate variability in determining prognosis post myocardial infarction and the risk of sudden cardiac death is well recognised. More recently, analysis of heart rate variability has found utility in predicting foetal deterioration, deterioration due to sepsis and impending multiorgan dysfunction syndrome in critically unwell adults. Moreover, reductions in heart rate variability have been associated with increased mortality in patients admitted to the intensive care unit. It is hypothesised that heart rate variability reflects and quantifies the neural regulation of organ systems such as the cardiovascular and respiratory systems. In disease states, it is thought that there is an ‘uncoupling’ of organ systems, leading to alterations in ‘inter-organ communication’ and a clinically detectable reduction in heart rate variability. Despite the increasing evidence of the utility of measuring heart rate variability, there remains debate as to the methodology that best represents clinically relevant outcomes. With continuing advances in technology, our understanding of the physiology responsible for heart rate variability evolves. In this article, we review the current understanding of the physiological basis of heart rate variability and the methods available for its measurement. Finally, we review the emerging use of heart rate variability analysis in intensive care medicine and conditions in which heart rate variability has shown promise as a potential physiomarker of disease.


2020 ◽  
Vol 8 (4) ◽  
pp. 46-66
Author(s):  
Natalia Shlyk ◽  
Alexander Alabuzhev

The aim of the study is to develop the standards of HRV indexes at rest and during an orthostatic challenge, taking into account different ranges of variability of cardiac intervals (MxDMn) of track and field athletes. The other purpose is to identify the features of changes in the standards in the training process in cases of malfunctions of cardioregulatory systems, sinus node functioning and recovery process, overtraining, and decrease in athletic performance. The authors used the results of individual dynamic express-tests of heart rate variability (HRV) in track and field athletes belonging to different specific training orientations to achieve the goals of the study. Research Methods and Organization. We carried out 1740 dynamic HRV measurements at rest and during an orthostatic challenge. The studies involved 56 track and field athletes (sprinters, middle distance runners and stayers) aged 18 to 29 years, belonging to the 1st adult category, Candidates Master of Sports and Masters of Sports, in different periods of the training process. We carried out HRV measurements in the laboratory of functional research methods of the Institute of physical culture and sports at Udmurt State University, as well as at training camps in the middle mountains (Kyrgyzstan, Kislovodsk) and on the plain (Elabuga). We examined the test subjects at rest in the morning after the previous training day, using the VARICARD 2.51 device and the ISCIM6 and VARICARD MP programs (Ryazan). We recorded cardio intervals of athletes for 5 minutes in lying position and for 6 minutes in standing position. We applied HRV measurements to one or four athletes simultaneously using the ISCIM6 and VARICARD MP programs. Research results. We assigned special emphasis to the assessment of changes in the variational range of cardiointervals (MxDMn) reflecting the state of cardiac regulation and the sinus node functioning during dynamic HRV studies in the training process of each runner. We identified seven MxDMn variation ranges from <150ms to >650ms. We revealed that each MxDMn variation range corresponds to a certain prevailing type of regulation. We demonstrated that frequent shifts of the MxDMn ranges from one level to another in the training process of runners indicate instability of cardiac regulation. We elaborated standards for the variational range of cardiointervals (MxDMn), taking into account the predominance of the HF and LF power in the HRV power spectrum for runners with different specific training orientations. We found that respiratory (HF) or vasomotor waves (LF) could prevail within the same MxDMn variation ranges, which points to a different autonomic balance. We revealed that at rest, the variational range of cardiointervals (MxDMn) depends more on the state of cardiac regulation and the sinus node functioning and less on the specifics of running. We often detected paradoxical reactions to an orthostatic challenge at low or extremely high MxDMn values in the overtrained runners. We determined that runners of any specific training orientation could increase their fitness, adaptive and reserve capabilities only in the context of the optimal regulation state, stable favorable ranges of MxDMn values, and the absence of paradoxical reactions to an orthostatic challenge. The paper contains tables with standard HRV indicators for different MxDMn variation ranges and consideration of the predominance of HF and LF waves at rest and during an orthostatic challenge, as well as examples of the results of HRV analysis at rest and during an orthostatic challenge in runners with different MxDMn variation ranges in the training process. Conclusion. The research demonstrated that the use of the HRV analysis method at rest and during an orthostatic challenge, taking into account the standards of MxDMn values in the training process of track and field athletes, is aimed at obtaining the necessary information about the stability of autonomic balance, autonomic reactivity and body reserves that ensure optimal adaptation and recovery processes.


EP Europace ◽  
2020 ◽  
Vol 22 (Supplement_1) ◽  
Author(s):  
R Piotrowski ◽  
A Zuk ◽  
J Baran ◽  
A Sikorska ◽  
T Krynski ◽  
...  

Abstract Funding Acknowledgements Centre of Postgraduate Medical Education No. 501-1-10-14-19 Background. Cardioneuroablation (CNA) - ablation of ganglionated plexi (GP) to eliminate or reduce parasympathetic overactivity, has been recently proposed as a new therapeutic method in patients with vaso-vagal syncope (VVS) due to cardioinhibitory or mixed mechanism. Purpose. To assess the impact of CNA on the type of VV response during tilt testing (TT). Methods. The study group consisted of the first 20 patients (7 males, mean age 38 ± 9 – year – old) enrolled in the ongoing prospective Roman study (NCT 03903744). All patients had a history of ECG documented syncope due to asystole and confirmed asystolic form of VVS at baseline TT. CNA was performed using electroanatomical system Carto 3 and radiofrequency applications delivered in the right and left atrium at the right anterior GP and right inferior GP sites. The second TT was performed three months later. Resting heart rate (HR) and heart rate variability parameter (SDDN) were also assessed. Results. At baseline TT, nineteen patients had cardioinhibitory syncope (asystole ranging from 3 to 60 s)  (sinus node arrest – 17 patients, A-V block – 2 patients) and 1 had mixed form of VVS (asystole lasting 3 s preceded by hypotension). During three-month follow-up no syncopal episodes were noted. At the 3-month TT, 6 (30 %) patients had no syncope whereas the remaining 13 (65 %)  had syncope – twelve (60 %) due to vasodepressor mechanism and only one (5 %) due to asystole - as before CNA. One patient did not have TT because of pregnancy. Mean resting HR after CNA was significantly faster and SDNN significantly lower than before the procedure (82 ± 9 vs 69 ± 11 beats/min, p = 0.0004 and 74 ± 22 vs 143 ± 40 ms, p = 0.00003, respectively) and these changes were was similar in those who fainted during second TT and those who did not (82 ± 11 vs 81 ± 4 beats/min, p = NS and (75 ± 2 vs 77 ± 18 ms, p = NS, respectively). Conclusions. CNA profoundly affects the type of VV reaction causing normalization of the response to tilting or changing cardiodepression to vasodepression. These effects are also depicted by changes in HR and heart rate variability. Elimination of TT-induced reflex asystole may prevent clinical recurrences of syncope during short-term follow-up. These findings encourage to conduct further studies involving CNA since this method appears to be effective and obviates the need for pacemaker implantation in young people with reflex asystolic syncope.


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