Fractal properties of human heart period variability: physiological and methodological implications

Fractal frequency scaling of heart period variability is used as a concise index of overall cardiac control. However, no prior study has assessed within-individual reproducibility of fractal indices of heart period, or reported how the estimated indices respond to autonomic blockade. Therefore, we examined fractal properties of the heart period from ten young, healthy individuals during three separate experimental sessions under control (saline) conditions and twice under combined autonomic blockade (atenolol and atropine sulfate) conditions. Under each condition, R-R intervals were recorded with the subject in the supine and the 40 deg upright tilt positions during 20 min of controlled breathing in each position. We calculated the fractal scaling exponent using detrended fluctuation analysis and estimated confidence intervals of the scaling exponents for each R-R interval time series within each individual. In the control condition, upright tilt significantly increased the scaling exponents (from 0.73 +/- 0.11 (+/- s.d., session 1), 0.72 +/- 0.10 (session 2) and 0.75 +/- 0.13 (session 3) to 0.82 +/- 0.12, 0.82 +/- 0.11 and 0.84 +/- 0.10; Student's paired t-test, t = 2.79, P = 0.02; t = 2.80, P = 0.02; and t = 2.07, P = 0.07). However, neither the absolute scaling exponents nor their change in response to upright tilt were reproducible (Lin's concordance coefficient less than 0.9, P > 0.1 for all comparisons). Following autonomic blockade, the scaling exponents were significantly increased (supine: 1.08 +/- 0.13 and 1.08 +/- 0.14; tilt: 1.07 +/- 0.21 and 1.08 +/- 0.14) for both experimental sessions (two-way repeated-measures ANOVA; F-17,F-1 = 40.89, P < 0.001 and F-17,F-1 = 42.72, P < 0.001) regardless of position. However, within individuals, the scaling exponents failed to distinguish between control and blockade for half of the subjects in at least one experimental session. Thus, fractal scaling exponents are not reproducible within individuals and do not reliably reflect the autonomic mechanisms responsible for heart period variability. In fact, data from combined blockade suggest that physiological effects of autonomic outflow may mask intrinsic fractal behaviour of the sinoatrial node.