title: Role of hypotension in heart rate turbulence physiology.
abstract: BACKGROUND
  Heart rate turbulence is a recently described cardiac prognostic marker that may be mediated by arterial baroreceptor sensitivity, suggesting it is induced by a brief initial hypotension.
  
  
  OBJECTIVE
  The purpose of this study was to assess whether heart rate turbulence could be noninvasively induced through a previously implanted defibrillator and whether hypotension modulates turbulence physiology.
  
  
  METHODS
  Premature ventricular paced beats was delivered during continuous ECG and blood pressure monitoring in patients with implanted defibrillators. Heart rate turbulence parameters from paced beats were compared with those from spontaneous premature ventricular beats. Subsequently, turbulence hemodynamic parameters were compared in 11 subjects with turbulence induced by pacing trains of 1, 3, 5, and 8 beats at a cycle length of 400 ms.
  
  
  RESULTS
  Heart rate turbulence was very similar whether it followed a spontaneous premature ventricular complex or a paced beat. Induced and spontaneous turbulence slopes correlated well (R(s) = 0.917, P = .001). With increasing pacing train length, the magnitude of hypotension, cumulative hypotension time from the last sinus beat, turbulence tachycardia magnitude, magnitude of hypertension in recovery, and turbulence onset (but not turbulence slope) all increased. The cumulative hypotension time, but not the magnitude of hypotension, was tightly correlated with the magnitude of tachycardia (R2 = 0.999, P = .003) and turbulence onset (R2 = 0.975, P = .01).
  
  
  CONCLUSIONS
  Heart rate turbulence can be induced noninvasively through an implanted device. Turbulence parameters are physiologically modulated by the duration of the initial hypotension, suggesting a possible important role for arterial baroreceptors.
authors.affiliation: Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University School of Medicine, Nashville, Tennessee, USA.
authors.forename: Satish R
authors.initials: SR
authors.lastname: Raj
authors.forename: Robert S
authors.initials: RS
authors.lastname: Sheldon
authors.forename: Marylou
authors.initials: M
authors.lastname: Koshman
authors.forename: Daniel E
authors.initials: DE
authors.lastname: Roach
mesh_terms: D000368:Aged; D017704:Baroreflex; D002304:Cardiac Pacing, Artificial; D017147:Defibrillators, Implantable; D004562:Electrocardiography; D004594:Electrophysiology; D005260:Female; D006339:Heart Rate / Q000502:physiology*; D006439:Hemodynamics; D006801:Humans; D007022:Hypotension / Q000503:physiopathology*; D008297:Male; D011379:Prognosis; D011446:Prospective Studies; D013617:Tachycardia, Supraventricular / Q000503:physiopathology*; D017180:Tachycardia, Ventricular / Q000503:physiopathology*; D013997:Time Factors