From the Departments of Internal Medicine and Physiology, Hunter Holmes
McGuire Department of Veterans Affairs Medical Center, and Medical College of
Virginia, Virginia Commonwealth University, Richmond.
Correspondence to J. Andrew Taylor, PhD, Cardiovascular Research Laboratory HRCA Research and Training Institute, 1200 Centre St, Boston, MA 02131. E-mail ataylor{at}mail.hrca.harvard.edu
Background—Survival of post–myocardial infarction patients
is related inversely to their levels of very-low-frequency (0.003 to
0.03 Hz) RR-interval variability. The physiological
basis for such oscillations is unclear. In our study, we
used blocking drugs to evaluate potential contributions of sympathetic
and vagal mechanisms and the
renin-angiotensin-aldosterone system to
very-low-frequency RR-interval variability in 10 young healthy
subjects.
Methods and Results—We recorded RR intervals and
arterial pressures during three separate sessions, with the
patient in supine and 40 degree upright tilt positions, during
20-minute frequency (0.25 Hz) and tidal volume–controlled breathing
after intravenous injections: saline (control), atenolol
(0.2 mg/kg, ß-adrenergic blockade), atropine sulfate (0.04 mg/kg,
parasympathetic blockade), atenolol and atropine (complete autonomic
blockade), and enalaprilat (0.02 mg/kg, ACE blockade). We integrated
fast Fourier transform RR-interval spectral power at very low (0.003 to
0.03 Hz), low (0.05 to 0.15 Hz), and respiratory (0.2 to 0.3 Hz)
frequencies. ß-Adrenergic blockade had no significant effect on
very-low- or low-frequency RR-interval power but increased respiratory
frequency power 2-fold. ACE blockade had no significant effect on low
or respiratory frequency RR-interval power but modestly (
Conclusions—Although very-low-frequency heart period rhythms are
influenced by the renin-angiotensin-aldosterone
system, as low and respiratory frequency RR-interval rhythms, they
depend primarily on the presence of parasympathetic outflow. Therefore
the prognostic value of very-low-frequency heart period
oscillations may derive from the fundamental importance of
parasympathetic mechanisms in cardiovascular health.
© 1998 American Heart Association, Inc.
Clinical Investigation and Reports
Mechanisms Underlying Very-Low-Frequency RR-Interval Oscillations in Humans
21%)
increased very-low-frequency power in the supine (but not upright tilt)
position (P<0.05). The most profound effects were
exerted by parasympathetic blockade: Atropine, given alone or with
atenolol, abolished nearly all RR-interval variability and decreased
very-low-frequency variability by 92%.
Key Words: receptors, adrenergic, beta • renin • heart rate • vagus nerve
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