Complex Interaction Between Low-Frequency APD Oscillations and Beat-to-Beat APD Variability in Humans Is Governed by the Sympathetic Nervous System

Overview

Journal Front Physiol

Date 2020 Feb 11

PMID 32038279

Citations 4

Authors

Stefan van Duijvenboden

Bradley Porter

Esther Pueyo

David Adolfo Sampedro-Puente

Jesus Fernandez-Bes

Baldeep Sidhu

Justin Gould

Michele Orini

Martin J Bishop

Ben Hanson

Pier Lambiase

Reza Razavi

Christopher A Rinaldi

Jaswinder S Gill

Peter Taggart

Affiliations

Soon will be listed here.

Abstract

Background: Recent clinical, experimental and modeling studies link oscillations of ventricular repolarization in the low frequency (LF) (approx. 0.1 Hz) to arrhythmogenesis. Sympathetic provocation has been shown to enhance both LF oscillations of action potential duration (APD) and beat-to-beat variability (BVR) in humans. We hypothesized that beta-adrenergic blockade would reduce LF oscillations of APD and BVR of APD in humans and that the two processes might be linked.

Methods And Results: Twelve patients with normal ventricles were studied during routine electrophysiological procedures. Activation-recovery intervals (ARI) as a conventional surrogate for APD were recorded from 10 left and 10 right ventricular endocardial sites before and after acute beta-adrenergic adrenergic blockade. Cycle length was maintained constant with right ventricular pacing. Oscillatory behavior of ARI was quantified by spectral analysis and BVR as the short-term variability. Beta-adrenergic blockade reduced LF ARI oscillations (8.6 ± 4.5 ms vs. 5.5 ± 3.5 ms, = 0.027). A significant correlation was present between the initial control values and reduction seen following beta-adrenergic blockade in LF ARI ( = 0.62, = 0.037) such that when initial values are high the effect is greater. A similar relationship was also seen in the beat-to beat variability of ARI ( = 0.74, = 0.008). There was a significant correlation between the beta-adrenergic blockade induced reduction in LF power of ARI and the witnessed reduction of beat-to-beat variability of ARI ( = 0.74, = 0.01). These clinical results accord with recent computational modeling studies which provide mechanistic insight into the interactions of LF oscillations and beat-to-beat variability of APD at the cellular level.

Conclusion: Beta-adrenergic blockade reduces LF oscillatory behavior of APD (ARI) in humans . Our results support the importance of LF oscillations in modulating the response of BVR to beta-adrenergic blockers, suggesting that LF oscillations may play role in modulating beta-adrenergic mechanisms underlying BVR.

Citing Articles

Periodic repolarization dynamics as predictor of risk for sudden cardiac death in chronic heart failure patients.

Palacios S, Cygankiewicz I, Bayes de Luna A, Pueyo E, Martinez J Sci Rep. 2021; 11(1):20546.

PMID: 34654872 PMC: 8519935. DOI: 10.1038/s41598-021-99861-1.

ECG Ventricular Repolarization Dynamics during Exercise: Temporal Profile, Relation to Heart Rate Variability and Effects of Age and Physical Health.

Hernandez-Vicente A, Hernando D, Vicente-Rodriguez G, Bailon R, Garatachea N, Pueyo E Int J Environ Res Public Health. 2021; 18(18).

PMID: 34574421 PMC: 8469015. DOI: 10.3390/ijerph18189497.

Emerging evidence for a mechanistic link between low-frequency oscillation of ventricular repolarization measured from the electrocardiogram T-wave vector and arrhythmia.

Taggart P, Pueyo E, van Duijvenboden S, Porter B, Bishop M, Sampedro-Puente D Europace. 2021; 23(9):1350-1358.

PMID: 33880542 PMC: 8427352. DOI: 10.1093/europace/euab009.

Low-Frequency Oscillations in Cardiac Sympathetic Neuronal Activity.

Ang R, Marina N Front Physiol. 2020; 11:236.

PMID: 32256390 PMC: 7093552. DOI: 10.3389/fphys.2020.00236.

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