Autonomic Modulation in Patients with Heart Failure Increases Beat-to-Beat Variability of Ventricular Action Potential Duration
Background: Exaggerated beat-to-beat variability of ventricular action potential duration (APD) is linked to arrhythmogenesis. Sympathetic stimulation has been shown to increase QT interval variability, but its effect on ventricular APD in humans has not been determined.Methods and Results: Eleven h...
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| Format: | Article |
| Language: | English |
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Frontiers Media S.A.
2017-05-01
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| Series: | Frontiers in Physiology |
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| Online Access: | http://journal.frontiersin.org/article/10.3389/fphys.2017.00328/full |
| _version_ | 1828872718889517056 |
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| author | Bradley Porter Martin J. Bishop Simon Claridge Jonathan Behar Benjamin J. Sieniewicz Jessica Webb Justin Gould Mark O'Neill Christopher A. Rinaldi Reza Razavi Jaswinder S. Gill Peter Taggart |
| author_facet | Bradley Porter Martin J. Bishop Simon Claridge Jonathan Behar Benjamin J. Sieniewicz Jessica Webb Justin Gould Mark O'Neill Christopher A. Rinaldi Reza Razavi Jaswinder S. Gill Peter Taggart |
| author_sort | Bradley Porter |
| collection | DOAJ |
| description | Background: Exaggerated beat-to-beat variability of ventricular action potential duration (APD) is linked to arrhythmogenesis. Sympathetic stimulation has been shown to increase QT interval variability, but its effect on ventricular APD in humans has not been determined.Methods and Results: Eleven heart failure patients with implanted bi-ventricular pacing devices had activation–recovery intervals (ARI, surrogate for APD) recorded from LV epicardial electrodes under constant RV pacing. Sympathetic activity was increased using a standard autonomic challenge (Valsalva) and baroreceptor indices were applied to determine changes in sympathetic stimulation. Two Valsalvas were performed for each study and were repeated, both off and on bisoprolol. In addition sympathetic nerve activity (SNA) was measured from skin electrodes on the thorax using a novel validated method. Autonomic modulation significantly increased mean short-term variability in ARI; off bisoprolol mean STV increased from 3.73 ± 1.3 to 5.27 ± 1.04 ms (p = 0.01), on bisoprolol mean STV of ARI increased from 4.15 ± 1.14 to 4.62 ± 1 ms (p = 0.14). Adrenergic indices of the Valsalva demonstrated significantly reduced beta-adrenergic function when on bisoprolol (Δ pressure recovery time, p = 0.04; Δ systolic overshoot in Phase IV, p = 0.05). Corresponding increases in SNA from rest both off (1.4 uV, p < 0.01) and on (0.7 uV, p < 0.01) bisoprolol were also seen.Conclusions: Beat-to-beat variability of ventricular APD increases during brief periods of increased sympathetic activity in patients with heart failure. Bisoprolol reduces, but does not eliminate, these effects. This may be important in the genesis of ventricular arrhythmias in heart failure patients. |
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| institution | Directory Open Access Journal |
| issn | 1664-042X |
| language | English |
| last_indexed | 2024-12-13T07:00:17Z |
| publishDate | 2017-05-01 |
| publisher | Frontiers Media S.A. |
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| series | Frontiers in Physiology |
| spelling | doaj.art-423db97da5e14fdda7f317046f50ddf02022-12-21T23:55:56ZengFrontiers Media S.A.Frontiers in Physiology1664-042X2017-05-01810.3389/fphys.2017.00328263557Autonomic Modulation in Patients with Heart Failure Increases Beat-to-Beat Variability of Ventricular Action Potential DurationBradley Porter0Martin J. Bishop1Simon Claridge2Jonathan Behar3Benjamin J. Sieniewicz4Jessica Webb5Justin Gould6Mark O'Neill7Christopher A. Rinaldi8Reza Razavi9Jaswinder S. Gill10Peter Taggart11Department of Imaging Sciences and Biomedical Engineering, Kings College LondonLondon, United KingdomDepartment of Imaging Sciences and Biomedical Engineering, Kings College LondonLondon, United KingdomDepartment of Imaging Sciences and Biomedical Engineering, Kings College LondonLondon, United KingdomDepartment of Imaging Sciences and Biomedical Engineering, Kings College LondonLondon, United KingdomDepartment of Imaging Sciences and Biomedical Engineering, Kings College LondonLondon, United KingdomDepartment of Imaging Sciences and Biomedical Engineering, Kings College LondonLondon, United KingdomDepartment of Imaging Sciences and Biomedical Engineering, Kings College LondonLondon, United KingdomCardiology Department, Guy's and St. Thomas' HospitalLondon, United KingdomCardiology Department, Guy's and St. Thomas' HospitalLondon, United KingdomDepartment of Imaging Sciences and Biomedical Engineering, Kings College LondonLondon, United KingdomCardiology Department, Guy's and St. Thomas' HospitalLondon, United KingdomDepartment of Cardiovascular Sciences, University College LondonLondon, United KingdomBackground: Exaggerated beat-to-beat variability of ventricular action potential duration (APD) is linked to arrhythmogenesis. Sympathetic stimulation has been shown to increase QT interval variability, but its effect on ventricular APD in humans has not been determined.Methods and Results: Eleven heart failure patients with implanted bi-ventricular pacing devices had activation–recovery intervals (ARI, surrogate for APD) recorded from LV epicardial electrodes under constant RV pacing. Sympathetic activity was increased using a standard autonomic challenge (Valsalva) and baroreceptor indices were applied to determine changes in sympathetic stimulation. Two Valsalvas were performed for each study and were repeated, both off and on bisoprolol. In addition sympathetic nerve activity (SNA) was measured from skin electrodes on the thorax using a novel validated method. Autonomic modulation significantly increased mean short-term variability in ARI; off bisoprolol mean STV increased from 3.73 ± 1.3 to 5.27 ± 1.04 ms (p = 0.01), on bisoprolol mean STV of ARI increased from 4.15 ± 1.14 to 4.62 ± 1 ms (p = 0.14). Adrenergic indices of the Valsalva demonstrated significantly reduced beta-adrenergic function when on bisoprolol (Δ pressure recovery time, p = 0.04; Δ systolic overshoot in Phase IV, p = 0.05). Corresponding increases in SNA from rest both off (1.4 uV, p < 0.01) and on (0.7 uV, p < 0.01) bisoprolol were also seen.Conclusions: Beat-to-beat variability of ventricular APD increases during brief periods of increased sympathetic activity in patients with heart failure. Bisoprolol reduces, but does not eliminate, these effects. This may be important in the genesis of ventricular arrhythmias in heart failure patients.http://journal.frontiersin.org/article/10.3389/fphys.2017.00328/fullarrhythmiaaction potential durationsympathetic nervous systemactivation recovery intervalbeta-blockerheart failure |
| spellingShingle | Bradley Porter Martin J. Bishop Simon Claridge Jonathan Behar Benjamin J. Sieniewicz Jessica Webb Justin Gould Mark O'Neill Christopher A. Rinaldi Reza Razavi Jaswinder S. Gill Peter Taggart Autonomic Modulation in Patients with Heart Failure Increases Beat-to-Beat Variability of Ventricular Action Potential Duration Frontiers in Physiology arrhythmia action potential duration sympathetic nervous system activation recovery interval beta-blocker heart failure |
| title | Autonomic Modulation in Patients with Heart Failure Increases Beat-to-Beat Variability of Ventricular Action Potential Duration |
| title_full | Autonomic Modulation in Patients with Heart Failure Increases Beat-to-Beat Variability of Ventricular Action Potential Duration |
| title_fullStr | Autonomic Modulation in Patients with Heart Failure Increases Beat-to-Beat Variability of Ventricular Action Potential Duration |
| title_full_unstemmed | Autonomic Modulation in Patients with Heart Failure Increases Beat-to-Beat Variability of Ventricular Action Potential Duration |
| title_short | Autonomic Modulation in Patients with Heart Failure Increases Beat-to-Beat Variability of Ventricular Action Potential Duration |
| title_sort | autonomic modulation in patients with heart failure increases beat to beat variability of ventricular action potential duration |
| topic | arrhythmia action potential duration sympathetic nervous system activation recovery interval beta-blocker heart failure |
| url | http://journal.frontiersin.org/article/10.3389/fphys.2017.00328/full |
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