British Journal of Anaesthesia, Vol 82, Issue 5 685-690, Copyright © 1999 by The Board of Management and Trustees of the British Journal of Anaesthesia
P. D. Larsen, P. Booth and D. C. Galletly
Cardioventilatory coupling is an entrainment phenomena, distinct from
respiratory sinus arrhythmia, whereby heart and breathing rhythms show
temporal coherence. Coupling is commonly observed during rest, sleep and
anaesthesia. Five graphical methods, each with different underlying
mechanistic assumptions, have been suggested for studying this entrainment
relationship: (a) time relationship between inspiration and a preceding
heart beat, (b) time relationship between inspiration and a following heart
beat, (c) phase of the cardiac cycle at which inspiration occurs, (d)
phases of the ventilatory cycle at which heart beats occur and (e)
'relative phases' over multiple ventilatory cycles at which heart beats
occur. In eight elderly human subjects with atrial fibrillation, breathing
spontaneously during general anaesthesia, we recorded heart period and
ventilatory time series and compared each of the graphical methods used for
demonstration of coupling. We observed cardioventilatory coupling in seven
of eight subjects. In each of these seven subjects, coupling was best
described, both qualitatively and quantitatively, in terms of the
relationship between inspiration and a preceding heart beat. The variation
of the interval between inspiration and a preceding heart beat was less
than for any other phase or time relationship. These data support a model
of cardioventilatory coupling in which a heart beat triggers the onset of
inspiration, rather than modulation of cardiac timing by ventilation or a
phase relationship between the two systems.
CLINICAL INVESTIGATIONS
Cardioventilatory coupling in atrial fibrillation
Section of Anaesthesia, Wellington School of Medicine, Mein Street, Newtown, PO Box 7343, Wellington, New Zealand
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