title: Respiratory sinus arrhythmia in humans: an obligatory role for vagal feedback from the lungs.
abstract: Respiratory sinus arrhythmia (RSA) is used as a noninvasive measure of vagal cardiac input, but its causative mechanisms in humans remain undetermined. We compared the RSA of five lung-denervated double-lung transplant patients with intact hearts to six normal (N) control subjects, five heart-denervated patients, and two liver transplant patients at matched tidal volumes (VT's) and breathing frequencies. In N and liver transplant subjects, RSA was significant during eupnea and increased two- to threefold with increasing VT and inspiratory effort. In heart- and lung-denervated subjects, RSA at eupnea was significant but was only 53% of that in N subjects and was not respondent to changing VT, inspiratory effort, or breathing frequency. We also compared the RSA of N subjects during voluntary (active) and passive positive pressure ventilation at normocapnia. RSA was reduced from 11 +/- 2.2 beats/min during active ventilation to 5.4 +/- 0.8 beats/min during PPV. We conclude that vagal feedback from pulmonary stretch receptors is obligatory for the generation of a neurally mediated RSA in awake humans at normal and raised levels of VT and respiratory motor output. In intact humans, we also hypothesize an important effect for nonpulmonary central and/or peripheral modulation of RSA. It is likely that the key mechanisms for neurally mediated RSA in unanesthetized humans are mutually dependent.
authors.affiliation: Department of Medicine, University of Wisconsin-Madison 53705, USA.
authors.forename: B H
authors.initials: BH
authors.lastname: Taha
authors.forename: P M
authors.initials: PM
authors.lastname: Simon
authors.forename: J A
authors.initials: JA
authors.lastname: Dempsey
authors.forename: J B
authors.initials: JB
authors.lastname: Skatrud
authors.forename: C
authors.initials: C
authors.lastname: Iber
mesh_terms: D000328:Adult; D001146:Arrhythmia, Sinus / Q000503:physiopathology*; D001794:Blood Pressure / Q000502:physiology; D003714:Denervation; D005246:Feedback / Q000502:physiology; D005260:Female; D006321:Heart / Q000294:innervation; D006339:Heart Rate / Q000502:physiology; D016027:Heart Transplantation / Q000502:physiology; D006801:Humans; D016031:Liver Transplantation / Q000502:physiology; D008168:Lung / Q000502:physiology*; D016040:Lung Transplantation / Q000502:physiology; D008297:Male; D008875:Middle Aged; D011175:Positive-Pressure Respiration; D011661:Pulmonary Stretch Receptors / Q000502:physiology; D015656:Respiratory Mechanics / Q000502:physiology*; D013990:Tidal Volume / Q000502:physiology; D014630:Vagus Nerve / Q000502:physiology*