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Published on: June 5, 2019
Hypothesis: Low frequency heart rate variability (LF-HRV) is an input for undisclosed yet biological adaptive
Uri Gabbay1, Ben Zion Bobrovsky
1Department of Epidemiology and Preventive Medicine, School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel. ugabai@post.tau.ac.il
Insights
We propose a fourth level of cardiovascular regulation: an adaptive loop using low-frequency heart rate variability (LF-HRV) as a reference. This may explain pacemaker syndrome and guide new treatments.
Area of Science:
- Cardiovascular Physiology
- Autonomic Nervous System Regulation
- Heart Rate Variability Analysis
Background:
- Current cardiovascular regulation models include autoregulation, neural, and hormonal control.
- The precise mechanisms underlying "pacemaker syndrome" remain incompletely understood.
- Low-frequency heart rate variability (LF-HRV) is a key indicator of autonomic function.
Purpose of the Study:
- To propose a novel, fourth hierarchical control level in cardiovascular regulation.
- To investigate the role of LF-HRV amplitude as a reference input in this adaptive loop.
- To provide a potential explanation for "pacemaker syndrome" and inform diagnostic strategies.
Main Methods:
- Hypothetical model development based on existing physiological data.
- Analysis of LF-HRV dynamics in the context of artificial cardiac pacing.
- Review of clinical observations related to "pacemaker syndrome".
Main Results:
- The proposed adaptive loop utilizes LF-HRV amplitude as a reference signal for neural cardiovascular centers.
- Absence of LF-HRV during artificial pacing aligns with the hypothesis and may explain "pacemaker syndrome".
- The model suggests that maintaining LF-HRV is crucial for optimal cardiovascular function.
Conclusions:
- A fourth, adaptive control loop in cardiovascular regulation, referencing LF-HRV, is hypothesized.
- This framework offers insights into cardiovascular morbidities like "pacemaker syndrome".
- Potential therapeutic strategies include modulating pacemaker output to restore LF-HRV and mitigate adverse effects.
Abstract:
Cardiovascular regulation is considered today as having three levels: autoregulations, neural regulations and hormonal regulations. We hypothesize that the cardiovascular regulation has an additional (fourth) control level which is outer, hierarchical (adaptive) loop where LF-HRV amplitude serves as a reference input which the neural cardiovascular center detects and responses in order to maintain LF-HRV around some prescribed level. Supporting evidences: LF-HRV absence during artificial cardiac pacing may be associated with "pacemaker syndrome" which had not been sufficiently understood regardless of apparently unimpaired cardiovascular performance. The hypothesis may provide an essential basis for understanding several cardiovascular morbidities and insight toward diagnostic measures and treatments (including but not limited to adding variability to the pulse generator of artificial pacemakers to eliminate "pace maker syndrome").
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