Physiological Mechanisms of Heart Rate Turbulence

Abstract

Our papers on HRT physiology covered several electrophysiological phenomena associated with turbulent behaviour of sinus nodal discharge after isolated premature beat. Some observations were fairly novel (AV nodal turbulence, QT-turbulence, and HRT after atrial premature complexes), others were confirmative or complementary to the findings of other authors (impact of left ventricular ejection fraction and coupling interval). All of them were helpful for even deeper understanding the fundamental principles involved in HRT that, consequently, may offer an explanation of why HRT is such a potent postinfarction risk stratifier. From the very beginning we tried to suggest that late deceleration phase of HRT does not simply reflect the vagal function but originates from a complex interplay of both sympathetic and parasympathetic systems. Our paper on HRT hemodynamics (Wichterle et al. 2006) together with the article by Segersen et al. (2007) added perhaps "the last piece to the heart turbulence puzzle", as appreciated in Heart Rhythm editorial by Munich working group (Bauer et al. 2007).