ABSTRACT Tracking beat-to-beat blood pressure noninvasively during ventricular arrhythmia (VA) is of great importance but rarely reported. The goal of our study was to investigate the

potential utility of the adjusted pulse transit time (APTT) to track beat-to-beat femoral systolic blood pressure (SBP) during VA. Patients who underwent radiofrequency ablation for

arrhythmias at Fuwai Hospital were enrolled. Electrocardiograms (ECGs), finger photoplethysmograms, and femoral arterial blood pressure were recorded simultaneously during VA. The APTT was

calculated as the ratio between the square of the conventional pulse transit time (cPTT) and the RR interval of the ECG waveform. Forty-five patients were enrolled in our study, and 22,849

the APTT to detect ≥30% decreases in femoral SBP was 0.903 (95% confidential interval, 0.895–0.911). In addition, the APTT performed better than the cPTT and RR interval in the above

analysis (all _P_ < 0.05). Therefore, the APTT has acceptable accuracy in tracking beat-to-beat femoral SBP and could detect substantially decreased femoral SBP. These findings indicate

that the APTT may be a promising noninvasive surrogate for invasive femoral SBP during VA. A multiparameter model combining APTT and other parameters is needed to further improve the

accuracy. Access through your institution Buy or subscribe This is a preview of subscription content, access via your institution ACCESS OPTIONS Access through your institution Subscribe to

this journal Receive 12 print issues and online access $259.00 per year only $21.58 per issue Learn more Buy this article * Purchase on SpringerLink * Instant access to full article PDF Buy

now Prices may be subject to local taxes which are calculated during checkout ADDITIONAL ACCESS OPTIONS: * Log in * Learn about institutional subscriptions * Read our FAQs * Contact customer

support SIMILAR CONTENT BEING VIEWED BY OTHERS DIFFERENT IMPACT FACTORS FOR ACCURATE OSCILLOMETRIC BLOOD PRESSURE MEASUREMENT BETWEEN SINUS RHYTHM AND ATRIAL FIBRILLATION Article 02 March

2021 BLOOD PRESSURE IN ATRIAL FIBRILLATION AND IN SINUS RHYTHM DURING AMBULATORY BLOOD PRESSURE MONITORING: DATA FROM THE TEMPLAR PROJECT Article Open access 23 October 2023 THE EFFECT OF

HEART RATE ON BLOOD PRESSURE MEASUREMENT IN PATIENTS WITH ATRIAL FIBRILLATION: A CROSS-SECTIONAL STUDY Article 25 March 2022 REFERENCES * John RM, Tedrow UB, Koplan BA, Albert CM, Epstein

LM, Sweeney MO, et al. Ventricular arrhythmias and sudden cardiac death. Lancet. 2012;380:1520–9. Article  Google Scholar  * Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ,

Curtis AB, et al. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of

Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2018;72:e91–e220. Article  Google Scholar  * Benchimol A,

Ellis JG, Dimond EG, Wu T. Hemodynamic consequences of atrial and ventricular arrhythmias in man. Am Heart J. 1965;70:775–88. Article  CAS  Google Scholar  * McGhee BH, Bridges EJ.

Monitoring arterial blood pressure: what you may not know. Crit Care Nurse. 2002;22:60–64. 66-70, 73 passim. Article  Google Scholar  * Lakhal K, Ehrmann S, Martin M, Faiz S, Réminiac F,

Cinotti R, et al. Blood pressure monitoring during arrhythmia: agreement between automated brachial cuff and intra-arterial measurements. Br J Anaesth. 2015;115:540–9. Article  CAS  Google

Scholar  * Lakhal K, Ehrmann S, Boulain T. Noninvasive BP monitoring in the critically Ill: time to abandon the arterial catheter? Chest. 2018;153:1023–39. Article  Google Scholar  * O’Brien

E, Asmar R, Beilin L, Imai Y, Mallion JM, Mancia G, et al. European Society of Hypertension recommendations for conventional, ambulatory and home blood pressure measurement. J Hypertens.

2003;21:821–48. Article  Google Scholar  * Scheer B, Perel A, Pfeiffer UJ. Clinical review: complications and risk factors of peripheral arterial catheters used for haemodynamic monitoring

in anaesthesia and intensive care medicine. Crit Care. 2002;6:199–204. Article  Google Scholar  * Gao M, Cheng H-M, Sung S-H, Chen C-H, Olivier NB, Mukkamala R. Estimation of pulse transit

time as a function of blood pressure using a nonlinear arterial tube-load model. IEEE Trans Biomed Eng. 2016;64:1524–34. Article  Google Scholar  * Mukkamala R, Hahn J-O, Inan OT, Mestha LK,

Kim C-S, Töreyin H, et al. Toward ubiquitous blood pressure monitoring via pulse transit time: theory and practice. IEEE Trans Biomed Eng. 2015;62:1879–901. Article  Google Scholar  * Block

RC, Yavarimanesh M, Natarajan K, Carek A, Mousavi A, Chandrasekhar A, et al. Conventional pulse transit times as markers of blood pressure changes in humans. Sci Rep. 2020;10:1–9. Article 

Google Scholar  * Ding X, Zhang YT. Pulse transit time technique for cuffless unobtrusive blood pressure measurement: from theory to algorithm. Biomed Eng Lett. 2019;9:37–52. Article  Google

Scholar  * Ding XR, Zhang YT, Liu J, Dai WX, Tsang HK. Continuous cuffless blood pressure estimation using pulse transit time and photoplethysmogram intensity ratio. IEEE Trans Biomed Eng.

2016;63:964–72. Article  Google Scholar  * Miao F, Fu N, Zhang YT, Ding XR, Hong X, He Q, et al. A novel continuous blood pressure estimation approach based on data mining techniques. IEEE J

Biomed Health Inf. 2017;21:1730–40. Article  Google Scholar  * Miao F, Liu ZD, Liu JK, Wen B, He QY, Li Y. Multi-sensor fusion approach for cuff-less blood pressure measurement. IEEE J

Biomed Health Inf. 2020;24:79–91. Article  Google Scholar  * Wippermann CF, Schranz D, Huth RG. Evaluation of the pulse wave arrival time as a marker for blood pressure changes in critically

ill infants and children. J Clin Monit. 1995;11:324–8. Article  CAS  Google Scholar  * Kim SH, Song JG, Park JH, Kim JW, Park YS, Hwang GS. Beat-to-beat tracking of systolic blood pressure

using noninvasive pulse transit time during anesthesia induction in hypertensive patients. Anesth Analg. 2013;116:94–100. Article  Google Scholar  * Payne RA, Symeonides CN, Webb DJ, Maxwell

SR. Pulse transit time measured from the ECG: an unreliable marker of beat-to-beat blood pressure. J Appl Physiol. 2006;100:136–41. Article  CAS  Google Scholar  * John Camm A, Nisam S.

European utilization of the implantable defibrillator: has 10 years changed the ‘enigma’? Europace. 2010;12:1063–9. Article  CAS  Google Scholar  * Lee J, Sohn J, Park J, Yang S, Lee S, Kim

HC. Novel blood pressure and pulse pressure estimation based on pulse transit time and stroke volume approximation. Biomed Eng Online. 2018;17:81. Article  Google Scholar  * Barral J-P,

Croibier A. Circulatory physiology. In: Barral J-P, Croibier A, eds. Visceral vascular manipulations. London UK: Churchill Livingstone Elsevier; 2011. p. 27–45. * Vlachopoulos C, O’Rourke M,

Nichols WW. McDonald’s blood flow in arteries: theoretical, experimental and clinical principles, 6th edn. Boca Raton, FL, USA: CRC Press; 2011. * Samet P. Hemodynamic sequelae of cardiac

arrhythmias. Circulation. 1973;47:399–407. Article  CAS  Google Scholar  * Lin WH, Ji N, Wang L, Li G. A characteristic filtering method for pulse wave signal quality. Assess Annu Int Conf

IEEE Eng Med Biol Soc. 2019;2019:603–6. Google Scholar  * Nabeel P, Kiran VR, Joseph J, Abhidev V, Sivaprakasam M. Local pulse wave velocity: theory, methods, advancements, and clinical

applications. IEEE Rev Biomed Eng. 2019;13:74–112. Article  Google Scholar  * Williams B, Mancia G, Spiering W, Agabiti Rosei E, Azizi M, Burnier M, et al. 2018 ESC/ESH Guidelines for the

management of arterial hypertension: The Task Force for the management of arterial hypertension of the European Society of Cardiology (ESC) and the European Society of Hypertension (ESH).

Eur Heart J. 2018;39:3021–104. Article  Google Scholar  * Baek HJ, Kim KK, Kim JS, Lee B, Park KS. Enhancing the estimation of blood pressure using pulse arrival time and two confounding

factors. Physiological Meas. 2009;31:145. Article  Google Scholar  * Putyatina YS. Measurement of arterial blood pressure by processing pulse wave data. In: Proceedings 3rd annual Siberian

Russian workshop on electron devices and materials (Erlagol, Russia). IEEE; 2002. p. 77–8. https://doi.org/10.1109/SREDM.2002.1024395. * Lin WH, Wang H, Samuel OW, Liu G, Huang Z, Li G. New

photoplethysmogram indicators for improving cuffless and continuous blood pressure estimation accuracy. Physiol Meas. 2018;39:025005. Article  Google Scholar  * Li Y, Wang Z, Zhang L, Yang

X, Song J. Characters available in photoplethysmogram for blood pressure estimation: beyond the pulse transit time. Australas Phys Eng Sci Med. 2014;37:367–76. Article  Google Scholar  *

Stergiou GS, Alpert B, Mieke S, Asmar R, Atkins N, Eckert S, et al. A universal standard for the validation of blood pressure measuring devices: Association for the Advancement of Medical

Instrumentation/European Society of Hypertension/International Organization for Standardization (AAMI/ESH/ISO) Collaboration Statement. Hypertension. 2018;71:368–74. Article  CAS  Google

Scholar  * Ding XR, Zhao N, Yang GZ, Pettigrew RI, Lo B, Miao F, et al. Continuous blood pressure measurement from invasive to unobtrusive: celebration of 200th birth anniversary of Carl

Ludwig. IEEE J Biomed Health Inf. 2016;20:1455–65. Article  Google Scholar  * Sharwood-Smith G, Bruce J, Drummond G. Assessment of pulse transit time to indicate cardiovascular changes

during obstetric spinal anaesthesia. Br J Anaesth. 2006;96:100–5. Article  CAS  Google Scholar  * Wagner DR, Roesch N, Harpes P, Körtke H, Plumer P, Saberin A, et al. Relationship between

pulse transit time and blood pressure is impaired in patients with chronic heart failure. Clin Res Cardiol. 2010;99:657–64. Article  Google Scholar  * Newlin DB. Relationships of pulse

transmission times to pre-ejection period and blood pressure. Psychophysiology. 1981;18:316–21. Article  CAS  Google Scholar  * Ding X, Zhang Y, Tsang HK. Impact of heart disease and

calibration interval on accuracy of pulse transit time-based blood pressure estimation. Physiol Meas. 2016;37:227–37. Article  Google Scholar  * Masè M, Mattei W, Cucino R, Faes L, Nollo G.

Feasibility of cuff-free measurement of systolic and diastolic arterial blood pressure. J Electrocardiol. 2011;44:201–7. Article  Google Scholar  * Mühlsteff J, Aubert XL, Schuett M.

Cuffless estimation of systolic blood pressure for short effort bicycle tests: the prominent role of the pre-ejection period In: Conf Proc IEEE Eng Med Biol Soc. IEEE; 2006. p. 5088–92.

https://doi.org/10.1109/IEMBS.2006.260275. * Instrumentation A. Non-invasive sphygmomanometers-part 2: clinical validation of automated measurement type. Arlington, VA: American National

Standard Arlington, VA, USA: Association for the Advancement of Medical Instrumentation; 2013. * Pagonas N, Schmidt S, Eysel J, Compton F, Hoffmann C, Seibert F, et al. Impact of atrial

fibrillation on the accuracy of oscillometric blood pressure monitoring. Hypertension. 2013;62:579–84. Article  CAS  Google Scholar  * Ohuchi H, Ohashi H, Watanabe K, Yamada O, Yagihara T,

Echigo S. Blood pressure dynamics during simulated ventricular tachycardia in patients after right ventricular outflow tract reconstruction mainly for tetralogy of Fallot compared with

patients after ventricular septal defect closure. Am J Cardiol. 2004;93:1445–8. a1412. Article  Google Scholar  * Armstrong MK, Schultz MG, Picone DS, Black JA, Dwyer N, Roberts-Thomson P,

et al. Brachial and radial systolic blood pressure are not the same. Hypertension. 2019;73:1036–41. Article  CAS  Google Scholar  * Chauhan S, Saxena N, Mehrotra S, Rao BH, Sahu M. Femoral

artery pressures are more reliable than radial artery pressures on initiation of cardiopulmonary bypass. J Cardiothorac Vasc Anesth. 2000;14:274–6. Article  CAS  Google Scholar  * Galluccio

ST, Chapman MJ, Finnis ME. Femoral-radial arterial pressure gradients in critically ill patients. Crit Care Resusc. 2009;11:34–8. PubMed  Google Scholar  Download references ACKNOWLEDGEMENTS

This study was supported in part by the National Natural Science Foundation of China (Nos. 61771465, U1913210), the Shenzhen Science and Technology Projects (No. JCYJ20180703145202065), and

the Strategic Priority CAS Project (XDB38040200, XDB38060100). We would like to thank AJE (http://www.aje.com/) for English language editing. AUTHOR INFORMATION Author notes * These authors

contributed equally: Fen Miao, Bin Zhou, Zengding Liu. * These authors jointly supervised this work: Ye Li, Min Tang. AUTHORS AND AFFILIATIONS * Key Laboratory for Health Informatics,

Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China Fen Miao, Zengding Liu, Bo Wen & Ye Li * Department of Cardiology, Laboratory of Heart Center,

Zhujiang Hospital, Southern Medical University, Guangzhou, China Bin Zhou * Fuwai Hospital, National Center for Cardiovascular Disease, State Key Lab of Cardiovascular Disease, National

Clinical Research Center of Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China Bin Zhou & Min Tang * Joint Engineering Research

Center for Health Big Data Intelligent Analysis Technology, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, China Ye Li Authors * Fen Miao View author

publications You can also search for this author inPubMed Google Scholar * Bin Zhou View author publications You can also search for this author inPubMed Google Scholar * Zengding Liu View

author publications You can also search for this author inPubMed Google Scholar * Bo Wen View author publications You can also search for this author inPubMed Google Scholar * Ye Li View

author publications You can also search for this author inPubMed Google Scholar * Min Tang View author publications You can also search for this author inPubMed Google Scholar CORRESPONDING

AUTHOR Correspondence to Min Tang. ETHICS DECLARATIONS CONFLICT OF INTEREST The authors declare no competing interests. ADDITIONAL INFORMATION PUBLISHER’S NOTE Springer Nature remains

neutral with regard to jurisdictional claims in published maps and institutional affiliations. SUPPLEMENTARY INFORMATION SUPPLEMENTARY INFORMATION RIGHTS AND PERMISSIONS Reprints and

permissions ABOUT THIS ARTICLE CITE THIS ARTICLE Miao, F., Zhou, B., Liu, Z. _et al._ Using noninvasive adjusted pulse transit time for tracking beat-to-beat systolic blood pressure during

ventricular arrhythmia. _Hypertens Res_ 45, 424–435 (2022). https://doi.org/10.1038/s41440-021-00795-y Download citation * Received: 16 May 2021 * Revised: 26 September 2021 * Accepted: 07

October 2021 * Published: 21 December 2021 * Issue Date: March 2022 * DOI: https://doi.org/10.1038/s41440-021-00795-y SHARE THIS ARTICLE Anyone you share the following link with will be able

to read this content: Get shareable link Sorry, a shareable link is not currently available for this article. Copy to clipboard Provided by the Springer Nature SharedIt content-sharing

initiative KEYWORDS * ventricular arrhythmias * systolic blood pressure * pulse transit time * photoplethysmogram * RR interval