Patients operated for tetralogy of fallot and with non-sustained ventricular tachycardia have reduced heart rate variability
Patients operated for tetralogy of fallot and with non-sustained ventricular tachycardia have reduced heart rate variability
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DOI：
10.1007/s00059-004-2501-8
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发表时间：
2004-05-01
期刊：
影响因子：
1.7
通讯作者：
Villain, E
中科院分区：
文献类型：
--
作者：
Butera, G;Bonnet, D;Villain, E
背景资料：研究法洛四联症（ToF）手术患者的心率变异性（HRV），并确定HRV和室性心动过速（VT.Patients and Methods）之间的任何相关性：我们研究了23例连续ToF手术患者的HRV（平均年龄14 +/- 6.6岁;平均随访10.6 +/- 5.2年）。7例患者进行了非持续性Won霍尔特监测。包括两个对照组：18名健康受试者和15名因其他先天性心脏病手术的患者。三组之间的年龄、手术年龄（手术组）、随访和平均心率无差异。计算四个时域和四个频域指标：RR间期的平均持续时间、所有RR间期的标准差（SD）、连续RR间期的均方差的平方根（r-MSSD）、相邻RR间期之间的差异百分比（pNN 50）、总功率（TP）、低频（LF）、高频（HF）和LF/HF比率。两个对照组的HRV指标相同，但ToF患者的HRV指标显著降低。在因ToF接受手术的患者中，7名非持续性VT患者的HRV指数显著低于无心律失常患者：SD（95 +/- 15 vs. 135 +/- 54 MS; P = 0.01），r-MSSD（26 +/- 9 vs. 45 +/- 20 ms; P = 0.03）、pNN 50（4.4 +/- 3.4 vs. 16.5 +/- 12.5%; p = 0.001）和HF（111 +/- 97 vs. 352 +/- 291 ms（2）; p = 0.009）。采用逐步多元回归分析，pNN 50、手术年龄、肺动脉返流程度和较高的右/左心室比值是VT的独立预测变量（p < 0.0001; r（2）= 0.85）。结论：ToF患者，尤其是室性心律失常患者，交感-迷走神经平衡明显受损，表现为迷走神经驱动力降低。
Background: To study heart rate variability (HRV) in patients operated for tetralogy of Fallot (ToF) and to identify any correlation between HRV and ventricular tachycardia (VT).Patients and Methods: We studied HRV in 23 consecutive patients operated for ToF (mean age 14 +/- 6.6 years; mean follow-up 10.6 +/- 5.2 years). Seven patients had non-sustained Won Holter monitoring. Two control groups were included: 18 healthy subjects and 15 patients operated for other congenital heart disease. There were no differences in age, age at surgery (in the operated groups), follow-up, and mean heart rate between the three groups. Four time and four frequency domain indices were calculated: mean duration of RR intervals, standard deviation of all RR intervals (SD), square root of the mean squared differences of successive RR intervals (r-MSSD), percent of differences between adjacent RR intervals (pNN50), total power (TP), low frequency (LF), high frequency (HF), and LF/HF ratio.Results: HRV indices were identical in the two control groups but were significantly reduced in patients with ToF. Within the patients who had been operated on for ToF, HRV indices were significantly lower in the seven with non-sustained VT than in those without arrhythmias: SD (95 +/- 15 vs. 135 +/- 54 MS; P = 0.01), r-MSSD (26 +/- 9 vs. 45 +/- 20 ms; P = 0.03), pNN50 (4.4 +/- 3.4 vs. 16.5 +/- 12.5%; p = 0.001) and HF (111 +/- 97 vs. 352 +/- 291 ms(2); p = 0.009). Using stepwise multivariate regression analysis, pNN50, age at surgery, degree of pulmonary regurgitation and higher right/left ventricular ratio were independent predictive variables for VT (p < 0.0001; r(2) = 0.85).Conclusions: ToF patients, particularly those with ventricular arrhythmias, have significant impairment of sympatho-vagal balance, characterized by a reduction of vagal drive.