Impact of Preceding Ventricular Premature Beats on Heart Rate Turbulence

BACKGROUND: Heart rate turbulence (HRT) has recently been introduced as a noninvasive tool for studying autonomic dysfunction. It presented short time fluctuation of sinus cycle length following single ventricular premature contraction (VPC). However, HRT parameters may be influenced by different factors. This study aimed to evaluate the possible influence of VPC frequency on HRT. METHODS: 24-h Holter recording was performed in patients with VPCs initially detected by 12-lead electrocardiography (ECG) in the outpatient department. The numbers of VPCs in 2- and 5-minute durations preceding each VPC tachogram were calculated. The HRT parameters and the numbers of the VPCs preceding VPC tachograms were analyzed. RESULTS: There were 23,122 available VPC tachograms from 107 healthy subjects included in the study. The turbulence onset (TO) value increased and the turbulence slope (TS) value decreased as VPC's frequency increased. The TO values rapidly increased when the number of VPCs was >15 beats in the 2-minute and >35 beats in the 5-minute durations. There was also a prominent decrease in TS values when the VPCs reached 14 and 30 beats in the 2- and 5-minute durations, respectively. CONCLUSION: Physiologic baroreflex may be attenuated under intensive stimulation, which is evidenced by blunted HRT parameters by frequent VPCs. Physiologic response to VPC's frequency may be related to baroreflex fatigue and is demonstrated as a sigmoid curve.