Evidence for a central origin of the low-frequency oscillation in RR-interval variability.

BACKGROUND Short-term variability of RR interval and blood pressure occurs predominantly at low frequency (LF; approximately 0.1 Hz) and high frequency (approximately 0.25 Hz). The arterial baroreflex is thought to be the predominant determinant of the LF component of RR variability. Patients with severe congestive heart failure (CHF) have an attenuated or absent LF oscillation in RR variability. The left ventricular assist device (LVAD) offers a unique possibility for analysis of spectral oscillations in RR interval independent of any effects of blood pressure that influence these oscillations via the baroreflex. METHODS AND RESULTS We performed spectral analysis of RR, blood pressure, and respiration in 2 patients with CHF before and after LVAD implantation. LF components of the RR-interval and blood pressure variability were absent in both CHF patients before LVAD implantation. After LVAD implantation, spectral analysis of the RR interval showed restoration of a clear and predominant LF oscillation in the native hearts of both patients, with no such oscillation evident in the blood pressure profile. CONCLUSIONS During total circulatory support with the LVAD, the LF oscillation in RR interval of the native heart, absent in CHF, is restored. This LF oscillation in RR interval occurs in the absence of LF oscillations in blood pressure and thus is unlikely to be explained by baroreflex mechanisms. Hence, the absence of LF oscillation in the RR interval in CHF is functional and is reversible by LVAD circulation. The presence of a predominant LF oscillation in RR interval independent of any oscillation in blood pressure suggests that the LF oscillation is a fundamental property of central autonomic outflow.

[1]  R Maestri,et al.  Physiology and pathophysiology of heart rate and blood pressure variability in humans: is power spectral analysis largely an index of baroreflex gain? , 1995, Clinical science.

[2]  J. Saul,et al.  Transfer function analysis of the circulation: unique insights into cardiovascular regulation. , 1991, The American journal of physiology.

[3]  A. Dornhorst,et al.  Respiratory Variations in Blood Pressure , 1952, Circulation.

[4]  J Strackee,et al.  Hemodynamic fluctuations and baroreflex sensitivity in humans: a beat-to-beat model. , 1987, The American journal of physiology.

[5]  A. Porta,et al.  Spectral analysis of sympathetic discharge, R-R interval and systolic arterial pressure in decerebrate cats. , 1992, Journal of the autonomic nervous system.

[6]  A Malliani,et al.  Influences of neural mechanisms on heart period and arterial pressure variabilities in quadriplegic patients. , 1994, The American journal of physiology.

[7]  S Cerutti,et al.  Spectral and cross-spectral analysis of heart rate and arterial blood pressure variability signals. , 1986, Computers and biomedical research, an international journal.

[8]  P. McCarthy,et al.  HeartMate implantable left ventricular assist device: bridge to transplantation and future applications. , 1995, The Annals of thoracic surgery.

[9]  R J Cohen,et al.  Assessment of autonomic regulation in chronic congestive heart failure by heart rate spectral analysis. , 1988, The American journal of cardiology.

[10]  A. Malliani,et al.  Cardiovascular Neural Regulation Explored in the Frequency Domain , 1991, Circulation.

[11]  M. Oz,et al.  Bridge experience with long-term implantable left ventricular assist devices. Are they an alternative to transplantation? , 1997, Circulation.

[12]  H. H. Ros,et al.  Effects of epidural analgesia and atropine on heart rate and blood pressure variability: implications for the interpretation of beat-to-beat fluctuations. , 1994, European Journal of Anaesthesiology.

[13]  G. Preiss,et al.  Patterns of sympathetic neuron activity associated with Mayer waves. , 1974, The American journal of physiology.

[14]  L Bernardi,et al.  Low-frequency spontaneous fluctuations of R-R interval and blood pressure in conscious humans: a baroreceptor or central phenomenon? , 1994, Clinical science.

[15]  J. Desantiago,et al.  Extracellular Mg(2+)-dependent Na+, K+, and Cl- efflux in squid giant axons. , 1994, American Journal of Physiology.

[16]  J K Triedman,et al.  Blood pressure modulation by central venous pressure and respiration. Buffering effects of the heart rate reflexes. , 1994, Circulation.

[17]  R. Cohen,et al.  Power spectrum analysis of heart rate fluctuation: a quantitative probe of beat-to-beat cardiovascular control. , 1981, Science.

[18]  宮川 清,et al.  Mechanisms of Blood Pressure Waves , 1984 .

[19]  J. Saul,et al.  Heart rate and muscle sympathetic nerve variability during reflex changes of autonomic activity. , 1990, The American journal of physiology.

[20]  M. Turiel,et al.  Power Spectral Analysis of Heart Rate and Arterial Pressure Variabilities as a Marker of Sympatho‐Vagal Interaction in Man and Conscious Dog , 1986, Circulation research.

[21]  A. Malliani,et al.  Heart rate variability. Standards of measurement, physiological interpretation, and clinical use , 1996 .

[22]  U. Hvass,et al.  Clinical study of normothermic cardiopulmonary bypass in 100 patients with coronary artery disease. , 1995, The Annals of thoracic surgery.

[23]  J. Thomas,et al.  Effect of the implantable left ventricular assist device on neuroendocrine activation in heart failure. , 1995, Circulation.

[24]  A. Porta,et al.  Relationship between spectral components of cardiovascular variabilities and direct measures of muscle sympathetic nerve activity in humans. , 1997, Circulation.

[25]  K. H. Wesseling,et al.  The Measurement of Continuous Finger Arterial Pressure Noninvasively in Stationary Subjects , 1986 .

[26]  R. Cohen,et al.  Hemodynamic regulation: investigation by spectral analysis. , 1985, The American journal of physiology.

[27]  M. Turiel,et al.  Sympathetic predominance followed by functional denervation in the progression of chronic heart failure. , 1995, European heart journal.

[28]  A Malliani,et al.  Presence of vasomotor and respiratory rhythms in the discharge of single medullary neurons involved in the regulation of cardiovascular system. , 1996, Journal of the autonomic nervous system.

[29]  M. Eriksen,et al.  Respiration‐synchronous fluctuations in stroke volume, heart rate and arterial pressure in humans. , 1993, The Journal of physiology.

[30]  G. Breithardt,et al.  Heart rate variability: standards of measurement, physiological interpretation and clinical use. Task Force of the European Society of Cardiology and the North American Society of Pacing and Electrophysiology. , 1996 .

[31]  E. Fallen,et al.  Power spectral analysis of heart rate variability: a noninvasive signature of cardiac autonomic function. , 1993, Critical reviews in biomedical engineering.

[32]  M Pagani,et al.  Absence of low-frequency variability of sympathetic nerve activity in severe heart failure. , 1997, Circulation.

[33]  D. Eckberg,et al.  Human autonomic rhythms: vagal cardiac mechanisms in tetraplegic subjects. , 1994, The Journal of physiology.

[34]  M. Piepoli,et al.  Origin of respiratory sinus arrhythmia in conscious humans. An important role for arterial carotid baroreceptors. , 1997, Circulation.

[35]  D L Eckberg,et al.  Fundamental relations between short-term RR interval and arterial pressure oscillations in humans. , 1996, Circulation.