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(Hypertension. 1999;34:1060-1065.)
© 1999 American Heart Association, Inc.

Scientific Contributions

Respiratory Systolic Pressure Variability During Atrial Fibrillation and Sinus Rhythm

Maria Vittoria Pitzalis; Francesco Massari; Cinzia Forleo; Agnese Fioretti; Roberto Colombo; Cataldo Balducci; Filippo Mastropasqua; Paolo Rizzon

From the Institute of Cardiology, University of Bari (M.V.P., C.F., C.B., A.F., P.R.), Bari, Italy; the Division of Cardiology, "Salvatore Maugeri" Foundation, IRCCS, Rehabilitation Institute of Cassano Murge (F. Massari, F. Mastropasqua), Bari, Italy; and Bioengineering Service, "Salvatore Maugeri" Foundation IRCCS, Veruno Medical Centre (R.C.), Veruno, Italy.

Correspondence to Maria Vittoria Pitzalis, MD, PhD, FESC, Institute of Cardiology, University of Bari, Piazza Giulio Cesare 11, 70124 Bari, Italy. E-mail pitzalis{at}tin.it

Abstract—Previous studies have found that respiratory variations of ventricular response in atrial fibrillation are infrequent and inconsistent. This asynchrony between heart rate and respiration may characterize the physiological mechanisms coupling heart rate and systolic blood pressure oscillations in the respiratory band. The aim of this study was to evaluate whether synchronous variations in systolic blood pressure and respiration depend on a simultaneous change in heart rate. Univariate and bivariate spectral analyses were made of the R-R interval, systolic blood pressure, and respiratory signals during controlled respiration (16 breaths/min) in 24 patients with atrial fibrillation before and after efficacious electrical cardioversion and in 24 age- and sex-matched control subjects. During atrial fibrillation, the spectral coherence between respiration and heart rate was low (0.18±0.03), but there was a high level of coherence between respiration and systolic blood pressure (0.67±0.05). After cardioversion, the coherence between respiration and heart rate increased to 0.86±0.04, whereas the geometric mean values of the concomitant respiratory systolic blood pressure oscillations decreased by 72% (from 21.1 to 5.9 mm Hg², P<0.001), which was similar to that observed in the control group (5.7 mm Hg²). These results confirm the inconsistent effect of respiration on heart rate response during atrial fibrillation and demonstrate that respiratory sinus arrhythmia is not a prerequisite for systolic blood pressure oscillations but may play an antioscillatory role in respiratory systolic blood pressure variability, which is probably mediated by arterial baroreflex mechanisms.

Key Words: arrhythmia • blood pressure • heart rate