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. 2007 Mar;4(3):284-9.
doi: 10.1016/j.hrthm.2006.10.020. Epub 2006 Nov 1.

Heart rate turbulence parameters correlate with post-premature ventricular contraction changes in muscle sympathetic activity

Nathan M Segerson  1 , Stephen L Wasmund, Moeen Abedin, Rakesh K Pai, Marcos Daccarett, Nazem Akoum, T Scott Wall, Richard C Klein, Roger A Freedman, Mohamed H Hamdan
Affiliations

Heart rate turbulence parameters correlate with post-premature ventricular contraction changes in muscle sympathetic activity

Nathan M Segerson et al. Heart Rhythm. 2007 Mar.

Abstract

Background: Heart rate turbulence (HRT) has been shown to be vagally mediated with a strong correlation to baroreflex indices. However, the relationship between HRT and peripheral sympathetic nerve activity (SNA) after a premature ventricular contraction (PVC) remains unclear.

Objective: We sought to evaluate the relationship between HRT and the changes in peripheral SNA after PVCs.

Methods: We recorded postganglionic muscle SNA during electrocardiogram monitoring in eight patients with spontaneous PVCs. Fifty-two PVCs were observed and analyzed for turbulence onset (TO) and slope (TS). SNA was quantified during (1) the dominant burst after the PVC (dominant burst area) and (2) the 10 seconds after the dominant burst (postburst SNA).

Results: The mean TO was 0.1% +/- 4.6%, and the mean TS was 6.1 +/- 6.6. The dominant burst area negatively correlated with TO (r = -0.50, P = .0002). The postburst SNA showed a significant positive correlation with TO (r = 0.44, P = .001) and a negative correlation with TS (r = -0.42, P = .002). These correlations remained significant after controlling for either the PVC coupling interval or the left ventricular ejection fraction.

Conclusions: Our findings highlight the relationship between perturbations in HRT and pathology in the sympathetic limb of the autonomic nervous system. Future studies are needed to evaluate the prognostic role of baroreflex control of sympathetic activity in patients with structural heart disease.

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Figures

Figure 1
Figure 1
Example recordings of ECG in Volts (V), blood pressure (BP) in mmHg, sympathetic nerve activity (SNA) in arbitrary units (AU), and the calculated cycle length (CL) trend in milliseconds from one episode. The change in diastolic blood pressure (ΔDBP) before and after the extrasystolic beat, and the slope of post-extrasystolic peaks 6 through 8 are also illustrated. In this example, there is a clear dominant burst (circled) 1.4 seconds after the premature beat, followed by the expected late sympathoinhibition.
Figure 2
Figure 2
Histograms of TO and TS measurements. TS exhibits a significant rightward skew in this population.
Figure 3
Figure 3
A) Scatterplot of TO versus Dominant-Burst Area in arbitrary units (AU). The linear estimate is superimposed. B) Scatterplot of TS versus Dominant-Burst Area, showing no significant correlation.
Figure 4
Figure 4
A) Scatterplot of TO versus Post-Burst SNA (a measure of late sympathoinhibition), in arbitrary units (AU), showing a modest but significant positive correlation. B) Scatterplot of TS versus Post-Burst SNA showing a negative correlation.
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References

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