Heart Rate Turbulence: Standards of Measurement, Physiological Interpretation, and Clinical Use

Abstract

This consensus statement has been compiled on behalf of the International Society for Holter and Noninvasive Electrophysiology. It reviews the topic of heart rate turbulence (HRT) and concentrates on technologies for measurement, physiologic background and interpretation, and clinical use of HRT. It also lists suggestions for future research. The phenomenon of HRT refers to sinus rhythm cycle-length perturbations after isolated premature ventricular complexes. The physiologic pattern of HRT consists of brief heart rate acceleration (quantified by the so-called turbulence onset) followed by more gradual heart rate deceleration (quantified by the so-called turbulence slope) before the rate returns to a pre-ectopic level. Available physiologic investigations confirm that the initial heart rate acceleration is triggered by transient vagal inhibition in response to the missed baroreflex afferent input caused by hemodynamically inefficient ventricular contraction. A sympathetically mediated overshoot of arterial pressure is responsible for the subsequent heart rate deceleration through vagal recruitment. Hence, the HRT pattern is blunted in patients with reduced baroreflex. The HRT pattern is influenced by a number of factors, provocations, treatments, and pathologies reviewed in this consensus. As HRT measurement provides an indirect assessment of baroreflex, it is useful in those clinical situations that benefit from baroreflex evaluation. The HRT evaluation has thus been found appropriate in risk stratification after acute myocardial infarction, risk prediction, and monitoring of disease progression in heart failure, as well as in several other pathologies.

Nonlinear Measures of Heart Rate Variability and Mortality Risk in Hemodialysis Patients

“…This is in contrast to their independent predictive power in post-MI patients (10,14,20). In this study, we observed modest (r=0.2-0.…”

“…HRT estimates cardiac baroreceptor reflex function from the responses of NN intervals to putative transient arterial pressure reduction caused by ventricular premature contraction (VPC). The patterns of responses are classified into the following categories: normal (category 0), partially abnormal (category 1), and abnormal (category 2) (9,12,20). This measure is available only when .5 isolated VPCs suitable for the analysis are obtained from 24-hour electrocardiography.…”

Effect of anti-arrhythmic drugs on non-invasive electrophysiologic indexes-predictors of sudden cardiac death

“…Для ТРС определяли показатели turbulence onset (ТО) (начало турбулентности -величина учащения сину-сового ритма после ЖЭ) и turbulence slopе (TS) (наклон турбулентности -интенсивность замедления синусового ритма после его учащения в постэкстрасистолическом пе-риоде). За патологические значения принимали ТО ≥0%, TS ≤2,5 мс/RR [7]. При отсутствии ЖЭ, пригодных для анализа за время ХМ, ТРС считали нормальной [7,8].…”

“…За патологические значения принимали ТО ≥0%, TS ≤2,5 мс/RR [7]. При отсутствии ЖЭ, пригодных для анализа за время ХМ, ТРС считали нормальной [7,8].…”

“…В представленном исследовании временная отмена β-адреноблокаторов не приводила к статистически значимым изменениям показателей ТРС и mTWA. A. Bauer и G. Schmidt [7] указывают на возмож-ность оценки ТРС без отмены β-адреноблокаторов. Наши данные позволяют подтвердить это предположение.…”