Reduced heart rate variability following repair of tetralogy of Fallot
Reduced heart rate variability following repair of tetralogy of Fallot
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DOI：
10.1136/hrt.81.6.656
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发表时间：
1999-06-01
期刊：
影响因子：
5.7
通讯作者：
Doig, WB
中科院分区：
文献类型：
--
作者：
McLeod, KA;Hillis, WS;Doig, WB
目的-检查法洛四联症修复术后 10 年或更长时间患者的自主神经功能，通过心率变异性评估，并将其与心脏结构、功能和心电图指数联系起来。方法-采用标准时域技术对 28 名年龄 12 至 34 岁（平均 19.5 岁）、至少 10 年前接受过法洛四联症修复的患者进行 24 小时动态心电图测量心率变异性。进行超声心动图评估左心室大小和功能、右心室大小和压力以及任何近端肺动脉狭窄。通过放射性核素扫描评估右心室功能。 QRS 持续时间、QT 间期和 QT 离散度在标准 12 导联 EGG 上测量。将心率变异性测量值与 28 名年龄匹配的健康对照者（平均年龄 19.9 岁）的值进行比较。使用 Pearson 相关系数和逐步回归分析来评估变量之间的相互关系。 结果：与年龄匹配的正常对照相比，28 名患者中有 12 名的心率变异性降低。心率变异性降低与年龄增加、右心室大小和压力增加以及 QRS 波群增宽相关。结论——心率变异性降低是法洛四联症修复术后的一个特征。它与年龄增长、右心室血流动力学受损和 QRS 波群增宽有关。在这种情况下，心率变异性降低可能是右心室功能恶化的标志。 QRS波持续时间延长已被确定为法洛四联症修复术后猝死的危险因素，而心脏自主控制受损可能是其中的机制之一。
Objective-To examine autonomic function as assessed by heart rate variability in patients 10 or more years after repair of tetralogy of Fallot, and to relate this to cardiac structure, function, and electrocardiographic indices.Methods-Heart rate variability was measured by standard time domain techniques on a 24 hour Holter ECG in 28 patients, aged 12 to 34 years (mean 19.5), who had undergone repair of tetralogy of Fallot at least 10 years previously. Echocardiography was performed to assess left ventricular size and function, right ventricular size and pressure, and any proximal pulmonary arterial stenosis. Right ventricular function was evaluated by radionuclide scan. QRS duration, QT interval, and QT dispersion were measured on a standard 12 lead EGG. Measurements of heart rate variability were compared with values from 28 age matched healthy controls (mean age 19.9 years). Interrelations between variables were assessed using Pearson correlation coefficients and stepwise regression analysis.Results-Heart rate variability was reduced, compared with values for age matched normal controls, in 12 of the 28 patients. Reduced heart rate variability was associated with increased age, increased right ventricular size and pressure, and widening of the QRS complex.Conclusions-Reduced heart rate variability is a feature following repair of tetralogy of Fallot. It is associated with increasing age, impaired right ventricular haemodynamics, and widening of the QRS complex. Under these circumstances, reduced heart rate variability may be a marker for deteriorating right ventricular function. Increased QRS duration has been identified as a risk factor for sudden death following repair of tetralogy of Fallot, and impaired cardiac autonomic control may be one of the mechanisms involved.