Inspiratory Resistance Improves Postural Tachycardia: A Randomized Study

Alfredo Gamboa, Sachin Y. Paranjape, Bonnie K. Black, Amy C. Arnold, Rocío Figueroa, Luis E. Okamoto, Victor C. Nwazue, Andre Diedrich, W. Dale Plummer, William D. Dupont, David Robertson, Satish R. Raj

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background - The objective of this study was to determine the effect of inspiratory resistance through an impedance threshold device (ITD) on orthostatic tolerance in patients with postural tachycardia syndrome. We hypothesized that the ITD would result in a greater negative intrathoracic pressure to enhance cardiac venous return, improve stroke volume, and reduce heart rate in these patients. Methods and Results - We compared the effect of a sham device (sham, no resistance) versus an ITD (increased inspiratory resistance) in 26 patients with postural tachycardia syndrome in a randomized, single-blind, crossover study. Hemodynamic assessments were performed at baseline while supine and during head-up tilt to 70° for 10 minutes. We did not find differences in baseline hemodynamic parameters between the ITD and the sham devices. After 10 minutes of head-up tilt, the heart rate was lower with the ITD versus sham device (102±4 versus 109±4 beat/min, respectively; P=0.003). The ITD also improved stroke volume compared with the sham device (35±2 versus 26±1 mL; P=0.006). Conclusions - These findings suggest that increasing negative intrathoracic pressure with ITD breathing improves heart rate control in patients with postural tachycardia syndrome during upright posture. Clinical Trial Registration - clinicaltrials.gov; Unique Identifier: NCT00962728.

Original languageEnglish (US)
Pages (from-to)651-658
Number of pages8
JournalCirculation: Arrhythmia and Electrophysiology
Volume8
Issue number3
DOIs
StatePublished - Jun 4 2015

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Tachycardia
Electric Impedance
Equipment and Supplies
Postural Orthostatic Tachycardia Syndrome
Heart Rate
Stroke Volume
Hemodynamics
Head
Single-Blind Method
Pressure
Posture
Cross-Over Studies
Respiration
Clinical Trials

All Science Journal Classification (ASJC) codes

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Cite this

Gamboa, A., Paranjape, S. Y., Black, B. K., Arnold, A. C., Figueroa, R., Okamoto, L. E., ... Raj, S. R. (2015). Inspiratory Resistance Improves Postural Tachycardia: A Randomized Study. Circulation: Arrhythmia and Electrophysiology, 8(3), 651-658. https://doi.org/10.1161/CIRCEP.114.002605
Gamboa, Alfredo ; Paranjape, Sachin Y. ; Black, Bonnie K. ; Arnold, Amy C. ; Figueroa, Rocío ; Okamoto, Luis E. ; Nwazue, Victor C. ; Diedrich, Andre ; Plummer, W. Dale ; Dupont, William D. ; Robertson, David ; Raj, Satish R. / Inspiratory Resistance Improves Postural Tachycardia : A Randomized Study. In: Circulation: Arrhythmia and Electrophysiology. 2015 ; Vol. 8, No. 3. pp. 651-658.
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Gamboa, A, Paranjape, SY, Black, BK, Arnold, AC, Figueroa, R, Okamoto, LE, Nwazue, VC, Diedrich, A, Plummer, WD, Dupont, WD, Robertson, D & Raj, SR 2015, 'Inspiratory Resistance Improves Postural Tachycardia: A Randomized Study', Circulation: Arrhythmia and Electrophysiology, vol. 8, no. 3, pp. 651-658. https://doi.org/10.1161/CIRCEP.114.002605

Inspiratory Resistance Improves Postural Tachycardia : A Randomized Study. / Gamboa, Alfredo; Paranjape, Sachin Y.; Black, Bonnie K.; Arnold, Amy C.; Figueroa, Rocío; Okamoto, Luis E.; Nwazue, Victor C.; Diedrich, Andre; Plummer, W. Dale; Dupont, William D.; Robertson, David; Raj, Satish R.

In: Circulation: Arrhythmia and Electrophysiology, Vol. 8, No. 3, 04.06.2015, p. 651-658.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Inspiratory Resistance Improves Postural Tachycardia

T2 - A Randomized Study

AU - Gamboa, Alfredo

AU - Paranjape, Sachin Y.

AU - Black, Bonnie K.

AU - Arnold, Amy C.

AU - Figueroa, Rocío

AU - Okamoto, Luis E.

AU - Nwazue, Victor C.

AU - Diedrich, Andre

AU - Plummer, W. Dale

AU - Dupont, William D.

AU - Robertson, David

AU - Raj, Satish R.

PY - 2015/6/4

Y1 - 2015/6/4

N2 - Background - The objective of this study was to determine the effect of inspiratory resistance through an impedance threshold device (ITD) on orthostatic tolerance in patients with postural tachycardia syndrome. We hypothesized that the ITD would result in a greater negative intrathoracic pressure to enhance cardiac venous return, improve stroke volume, and reduce heart rate in these patients. Methods and Results - We compared the effect of a sham device (sham, no resistance) versus an ITD (increased inspiratory resistance) in 26 patients with postural tachycardia syndrome in a randomized, single-blind, crossover study. Hemodynamic assessments were performed at baseline while supine and during head-up tilt to 70° for 10 minutes. We did not find differences in baseline hemodynamic parameters between the ITD and the sham devices. After 10 minutes of head-up tilt, the heart rate was lower with the ITD versus sham device (102±4 versus 109±4 beat/min, respectively; P=0.003). The ITD also improved stroke volume compared with the sham device (35±2 versus 26±1 mL; P=0.006). Conclusions - These findings suggest that increasing negative intrathoracic pressure with ITD breathing improves heart rate control in patients with postural tachycardia syndrome during upright posture. Clinical Trial Registration - clinicaltrials.gov; Unique Identifier: NCT00962728.

AB - Background - The objective of this study was to determine the effect of inspiratory resistance through an impedance threshold device (ITD) on orthostatic tolerance in patients with postural tachycardia syndrome. We hypothesized that the ITD would result in a greater negative intrathoracic pressure to enhance cardiac venous return, improve stroke volume, and reduce heart rate in these patients. Methods and Results - We compared the effect of a sham device (sham, no resistance) versus an ITD (increased inspiratory resistance) in 26 patients with postural tachycardia syndrome in a randomized, single-blind, crossover study. Hemodynamic assessments were performed at baseline while supine and during head-up tilt to 70° for 10 minutes. We did not find differences in baseline hemodynamic parameters between the ITD and the sham devices. After 10 minutes of head-up tilt, the heart rate was lower with the ITD versus sham device (102±4 versus 109±4 beat/min, respectively; P=0.003). The ITD also improved stroke volume compared with the sham device (35±2 versus 26±1 mL; P=0.006). Conclusions - These findings suggest that increasing negative intrathoracic pressure with ITD breathing improves heart rate control in patients with postural tachycardia syndrome during upright posture. Clinical Trial Registration - clinicaltrials.gov; Unique Identifier: NCT00962728.

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