Document Detail

Cardiorespiratory interactions in patients with atrial flutter.
MedLine Citation:
PMID:  19023018     Owner:  NLM     Status:  MEDLINE    
Respiratory sinus arrhythmia (RSA) is generally known as the autonomically mediated modulation of the sinus node pacemaker frequency in synchrony with respiration. Cardiorespiratory interactions have been largely investigated during sinus rhythm, whereas little is known about interactions during reentrant arrhythmias. In this study, cardiorespiratory interactions at the atrial and ventricular level were investigated during atrial flutter (AFL), a supraventricular arrhythmia based on a reentry, by using cross-spectral analysis and computer modeling. The coherence and phase between respiration and atrial (gamma(AA)(2), phi(AA)) and ventricular (gamma(RR)(2), phi(RR)) interval series were estimated in 20 patients with typical AFL (68.0 +/- 8.8 yr) and some degree of atrioventricular (AV) conduction block. In all patients, atrial intervals displayed oscillations strongly coupled and in phase with respiration (gamma(AA)(2)= 0.97 +/- 0.05, phi(AA) = 0.71 +/- 0.31 rad), corresponding to a paradoxical lengthening of intervals during inspiration. The modulation pattern was frequency independent, with in-phase oscillations and short time delays (0.40 +/- 0.15 s) for respiratory frequencies in the range 0.1-0.4 Hz. Ventricular patterns were affected by AV conduction type. In patients with fixed AV conduction, ventricular intervals displayed oscillations strongly coupled (gamma(RR)(2)= 0.97 +/- 0.03) and in phase with respiration (phi(RR) = 1.08 +/- 0.80 rad). Differently, in patients with variable AV conduction, respiratory oscillations were secondary to Wencheback rhythmicity, resulting in a decreased level of coupling (gamma(RR)(2)= 0.50 +/- 0.21). Simulations with a simplified model of AV conduction showed ventricular patterns to originate from the combination of a respiratory modulated atrial input with the functional properties of the AV node. The paradoxical frequency-independent modulation pattern of atrial interval, the short time delays, and the complexity of ventricular rhythm characterize respiratory arrhythmia during AFL and distinguish it from normal RSA. These peculiar features can be explained by assuming a direct mechanical action of respiration on AFL reentrant circuit.
Michela Masè; Marcello Disertori; Flavia Ravelli
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Publication Detail:
Type:  Journal Article     Date:  2008-11-20
Journal Detail:
Title:  Journal of applied physiology (Bethesda, Md. : 1985)     Volume:  106     ISSN:  8750-7587     ISO Abbreviation:  J. Appl. Physiol.     Publication Date:  2009 Jan 
Date Detail:
Created Date:  2009-01-09     Completed Date:  2009-02-19     Revised Date:  2013-09-26    
Medline Journal Info:
Nlm Unique ID:  8502536     Medline TA:  J Appl Physiol (1985)     Country:  United States    
Other Details:
Languages:  eng     Pagination:  29-39     Citation Subset:  IM    
Dept. of Physics, Univ. of Trento, Via Sommarive 14, 38050 Povo-Trento, Italy.
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MeSH Terms
Atrial Flutter / physiopathology*
Atrial Function*
Atrioventricular Node / physiopathology*
Computer Simulation
Heart Rate*
Middle Aged
Models, Cardiovascular
Respiratory Mechanics*
Signal Processing, Computer-Assisted
Time Factors
Ventricular Function*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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