Sympathetic neural activation: An ordered affair

Is there an ordered pattern in the recruitment of postganglionic sympathetic neurones? Using new multi-unit action potential detection and analysis techniques we sought to determine whether the activation of sympathetic vasomotor neurones during stress is governed by the size principle of recruitment. Multi-unit postganglionic sympathetic activity (fibular nerve) was collected from five male subjects at rest and during periods of elevated sympathetic stress (end-inspiratory apnoeas; 178 ± 37 s(mean ± S.D.)). Compared to baseline (0.24 ± 0.04 V), periods of elevated stress resulted in augmented sympathetic burst size (1.34 ± 0.38 V, P \u3c 0.05). Increased burst size was directly related to both the number of action potentials within a multi-unit burst of postganglionic sympathetic activity (r= 0.88 ± 0.04, P \u3c 0.001 in all subjects), and the amplitude of detected action potentials (r= 0.88 ± 0.06, P \u3c 0.001 in all subjects). The recruitment of larger, otherwise silent, neurons accounted for approximately 74% of the increase in detected action potentials across burst sizes. Further, action potential conduction velocities (inverse of latencies) were increased as a function of action potential size (R2= 0.936, P= 0.001). As axon diameter is positively correlated with action potential size and conduction velocity, these data suggest that the principle of ordered recruitment based on neuronal size applies to postganglionic sympathetic vasomotor neurones. This information may be pertinent to our understanding of reflex-specific recruitment strategies in postganglionic sympathetic nerves, patterns of vasomotor control during stress, and the malleability of sympathetic neuronal properties and recruitment in health and disease.The sympathetic nervous system is an important controller of blood pressure and blood flow to critical tissues and organs. In other neural systems (e.g. the skeletal motor system) there is a well understood pattern of neural recruitment during activation. Alternatively, our understanding of how sympathetic neurones are coordinated during stress is limited. We demonstrate that during stress otherwise silent sympathetic neurones are activated in an order based on neuronal size (from smallest to largest). This recruitment pattern is similar to what is known in other neural systems. This information has important implications for how blood pressure and blood flow are controlled, and the malleability of sympathetic activation in health and disease. © 2010 The Authors. Journal compilation © 2010 The Physiological Society

Teaching physiology: blood pressure and heart rate changes in simulated diving

Background and Purpose: Physiology exercise employing simulated diving is used in our curriculum to integrate knowledge in cardio-respiratory physiology. Aim was to improve model used in physiology exercise by employing continuous recordings of arterial pressure and heart rate. Materials and Methods: Total of 55 medical and dental students volunteered for the exercise. They were instrumented with photoplethysmographic blood pressure and heart rate device, as well as with pulse oxymetry. Continuous measurement of variables was undertaken while students performed apneas or breathed through snorkel in air or in cold water, or temperature change was applied to their forehead. Results: Employment of continuous recordings enabled detailed insight into changes in selected cardiovascular parameters during 30 seconds breathholding. Time course of the changes showed marked biphasic response. When face was submerged in cold water during apnea, arterial pressure initially decreased and heart rate increased. At the end of breath-hold, arterial pressure increased and heart rate decreased, respectively. Corresponding changes were less pronounced when breath-hold was performed without face immersion. Conclusion: Improved protocol in laboratory exercise enabled us to show two distinct phases in changes of cardiovascular variables which are characteristic of diving reflex. We showed students how modern technology can improve their studies in near future and encouraged and motivate them to participate actively in exercise

Comparison of procedural efficacy and biophysical parameters between two competing cryoballoon technologies for pulmonary vein isolation: Insights from an initial multicenter experience

Introduction: Recently a novel cryoballoon system (POLARx, Boston Scientific) became available for the treatment of atrial fibrillation. This cryoballoon is comparable with Arctic Front Advance Pro (AFA-Pro, Medtronic), however, it maintains a constant balloon pressure. We compared the procedural efficacy and biophysical characteristics of both systems. Methods: One hundred and ten consecutive patients who underwent first-time cryoballoon ablation (POLARx: n = 57; AFA-Pro: n = 53) were included in this prospective cohort study. Results: Acute isolation was achieved in 99.8% of all pulmonary veins (POLARx: 99.5% vs. AFA-Pro: 100%, p = 1.00). Total procedure time (81 vs. 67 min, p <.001) and balloon in body time (51 vs. 35 min, p <.001) were longer with POLARx. After a learning curve, these times were similar. Cryoablation with POLARx was associated with shorter time to balloon temperature −30°C (27 vs. 31 s, p <.001) and −40°C (32 vs. 54 s, p <.001), lower balloon nadir temperature (−55°C vs. −47°C, p <.001), and longer thawing time till 0°C (16 vs. 9 s, p <.001). There were no differences in time-to-isolation (TTI; POLARx: 45 s vs. AFA-Pro 43 s, p =.441), however, POLARx was associated with a lower balloon temperature at TTI (−46°C vs. −37°C, p <.001). Factors associated with acute isolation differed between groups. The incidence of phrenic nerve palsy was comparable (POLARx: 3.5% vs. AFA-Pro: 3.7%). Conclusion: The novel cryoballoon is comparable to AFA-Pro and requires only a short learning curve to get used to the slightly different handling. It was associated with faster cooling rates and lower

Ventilatory restraint of sympathetic activity during chemoreflex stress

The within-breath modulation of muscle sympathetic nerve activity (MSNA) is well established, with greater activity occurring during expiration and less during inspiration. Whether ventilation per se affects the longer-term (i.e., minute-to-minute) regulation of MSNA has not been determined. We sought to define the specific role of ventilation in regulating sympathetic activation during chemoreflex activation, where both ventilation and MSNA are increased. Ten young healthy subjects performed both asphyxic rebreathing and repeated, rebreathing apneas to cause the same magnitude of chemoreflex stress in the presence or absence of ventilation. Both protocols caused increases in sympathetic burst frequency, burst amplitude, and burst incidence. However, burst frequency was increased more during repeated apneas (12 ± 6 to 25 ± 7 bursts/min) compared with rebreathing (12 ± 5 to 17 ± 7 bursts/min; P \u3c 0.001) due to a greater burst incidence during apneas (36 ± 11 bursts/100 heart beats) vs. rebreathing (26 ± 8 bursts/100 heart beats, P \u3c 0.001). The sympathetic gain to chemoreflex stress was also larger during repeated apneas (2.29 ± 1.29 au/% desaturation) compared with rebreathing (1.44 ± 0.53 au/% desaturation, P \u3c 0.05). The augmented sympathetic response during apneas was associated with a larger pressor response and total peripheral resistance compared with rebreathing. These data demonstrate that ventilation per se restrains sympathetic activation during chemoreflex activation. Further, the augmented sympathetic response during apneas was associated with greater cardiovascular stress and may be relevant to the cardiovascular pathology associated with sleep-disordered breathing. Copyright © 2010 the American Physiological Society

Dynamic cerebral autoregulation is acutely impaired during maximal apnoea in trained divers.

AIMS: To examine whether dynamic cerebral autoregulation is acutely impaired during maximal voluntary apnoea in trained divers. METHODS: Mean arterial pressure (MAP), cerebral blood flow-velocity (CBFV) and end-tidal partial pressures of O2 and CO2 (PETO2 and PETCO2) were measured in eleven trained, male apnoea divers (28 ± 2 yr; 182 ± 2 cm, 76 ± 7 kg) during maximal "dry" breath holding. Dynamic cerebral autoregulation was assessed by determining the strength of phase synchronisation between MAP and CBFV during maximal apnoea. RESULTS: The strength of phase synchronisation between MAP and CBFV increased from rest until the end of maximal voluntary apnoea (P<0.05), suggesting that dynamic cerebral autoregulation had weakened by the apnoea breakpoint. The magnitude of impairment in dynamic cerebral autoregulation was strongly, and positively related to the rise in PETCO2 observed during maximal breath holding (R (2) = 0.67, P<0.05). Interestingly, the impairment in dynamic cerebral autoregulation was not related to the fall in PETO2 induced by apnoea (R (2) = 0.01, P = 0.75). CONCLUSIONS: This study is the first to report that dynamic cerebral autoregulation is acutely impaired in trained divers performing maximal voluntary apnoea. Furthermore, our data suggest that the impaired autoregulatory response is related to the change in PETCO2, but not PETO2, during maximal apnoea in trained divers

Teaching physiology: blood pressure and heart rate changes in simulated diving

Background and Purpose: Physiology exercise employing simulated diving is used in our curriculum to integrate knowledge in cardio-respiratory physiology. Aim was to improve model used in physiology exercise by employing continuous recordings of arterial pressure and heart rate. Materials and Methods: Total of 55 medical and dental students volunteered for the exercise. They were instrumented with photoplethysmographic blood pressure and heart rate device, as well as with pulse oxymetry. Continuous measurement of variables was undertaken while students performed apneas or breathed through snorkel in air or in cold water, or temperature change was applied to their forehead. Results: Employment of continuous recordings enabled detailed insight into changes in selected cardiovascular parameters during 30 seconds breathholding. Time course of the changes showed marked biphasic response. When face was submerged in cold water during apnea, arterial pressure initially decreased and heart rate increased. At the end of breath-hold, arterial pressure increased and heart rate decreased, respectively. Corresponding changes were less pronounced when breath-hold was performed without face immersion. Conclusion: Improved protocol in laboratory exercise enabled us to show two distinct phases in changes of cardiovascular variables which are characteristic of diving reflex. We showed students how modern technology can improve their studies in near future and encouraged and motivate them to participate actively in exercise

The Effects of Involuntary Respiratory Contractions on Cerebral Blood Flow during Maximal Apnoea in Trained Divers.

The effects of involuntary respiratory contractions on the cerebral blood flow response to maximal apnoea is presently unclear. We hypothesised that while respiratory contractions may augment left ventricular stroke volume, cardiac output and ultimately cerebral blood flow during the struggle phase, these contractions would simultaneously cause marked 'respiratory' variability in blood flow to the brain. Respiratory, cardiovascular and cerebrovascular parameters were measured in ten trained, male apnoea divers during maximal 'dry' breath holding. Intrathoracic pressure was estimated via oesophageal pressure. Left ventricular stroke volume, cardiac output and mean arterial pressure were monitored using finger photoplethysmography, and cerebral blood flow velocity was obtained using transcranial ultrasound. The increasingly negative inspiratory intrathoracic pressure swings of the struggle phase significantly influenced the rise in left ventricular stroke volume (R (2) = 0.63, P<0.05), thereby contributing to the increase in cerebral blood flow velocity throughout this phase of apnoea. However, these contractions also caused marked respiratory variability in left ventricular stroke volume, cardiac output, mean arterial pressure and cerebral blood flow velocity during the struggle phase (R (2) = 0.99, P<0.05). Interestingly, the magnitude of respiratory variability in cerebral blood flow velocity was inversely correlated with struggle phase duration (R (2) = 0.71, P<0.05). This study confirms the hypothesis that, on the one hand, involuntary respiratory contractions facilitate cerebral haemodynamics during the struggle phase while, on the other, these contractions produce marked respiratory variability in blood flow to the brain. In addition, our findings indicate that such variability in cerebral blood flow negatively impacts on struggle phase duration, and thus impairs breath holding performance

Firing patterns of muscle sympathetic neurons during short-term use of continuous positive airway pressure in healthy subjects and in chronic heart failure patients

The current study tested the hypothesis that modification in central hemodynamics during short-term continuous positive airway pressure (CPAP) application was accompanied by altered firing patterns of sympathetic nerve activity in CHF patients and healthy subjects.Muscle sympathetic nerve activity (MSNA), hemodynamic and ventilatory parameters were obtained from 8 healthy middle aged subjects and 7 CHF patients. Action potentials (APs) were extracted from MSNA neurograms, quantified as AP frequency and classified into different sized clusters. While on CPAP at 10cm H2O, multi-unit MSNA, AP frequency and mean burst area/min increased in healthy middle aged subjects (p\u3c0.05) whereas CPAP had no effect on these variables in CHF patients. In conclusion, the impact of CPAP on central hemodynamics in healthy individuals elicited a moderate activation of sympathetic neurons through increased AP firing frequency, whereas in CHF patients both hemodynamics and MSNA remained unaltered. © 2013 Elsevier B.V