Initiating mechanisms of paroxysmal atrial fibrillation
Initiating mechanisms of paroxysmal atrial fibrillation
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DOI：
10.1053/eupc.2002.0273
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发表时间：
2003-01-01
期刊：
影响因子：
6.1
通讯作者：
Jordaens, LJ
中科院分区：
文献类型：
--
作者：
Dimmer, C;Szili-Torok, T;Jordaens, LJ
背景了解阵发性心房颤动（AF）的发病机制有助于制定预防治疗方案。阵发性房颤发作前的特定心率（HR）模式和自主神经变化尚未得到充分研究。本研究采用无抗心律失常药物的患者24小时动态心电图分析，评估房颤发病前HR和心率变异性（HRV）的变化。方法与结果分析27例房颤48例，房颤发作时间大于30 s，房颤发作前有1 h以上的窦性心律。AF前一小时分为5分钟和30分钟两个时间段。最后15次心跳的心率也被分析。在21%的发作中，心率在最后5分钟内下降大于或等于5%（定义为减速）；它在37%（定义为加速度）中增加大于或等于5%。总组的HR、标准差（SD）和校正RR区间的SD在最后5 min发生了显著变化。在这两个亚组中，在30分钟内已经可以看到加速和减速；SD的变化仅在加速器中可见。心房早搏（PACs）的数量在房颤前增加，在加速器中最明显。光谱HRV分析未发现其他信息。结论：HR、SD的变化和PACs数量的增加预示着发病前至少30分钟的房颤，在加速者中更为明显。频谱HRV参数对预测房颤发作没有帮助。这可能对器械治疗有启示。(C) 2003欧洲心脏病学会。Elsevier Science Ltd.出版。版权所有。
Background The understanding of the onset mechanisms of paroxysmal atrial fibrillation (AF) may help to develop preventive therapy. Specific heart rate (HR) patterns and autonomic changes immediately before the onset of paroxysmal AF are not fully investigated. We undertook the present study to assess HR and heart rate variability (HRV) changes before the onset of AF using 24-h Holter electrocardiographic analysis in patients without antiarrhythmic medication.Methods and Results In 27 patients, 48 episodes of AF, lasting more than 30 s and preceded by sinus rhythm for more than 1 h were analysed. The hour preceding AF was divided in 5- and 30 min blocks. HR was also analysed in the last 15 beats. In 21% of the episodes, HR decreased greater than or equal to5% in the last 5 min (defined as deceleration); it increased greater than or equal to5% in 37% (defined as acceleration). HR, standard deviation (SD) and SD corrected for RR interval changed significantly in the last 5 min in the total group. Acceleration and deceleration were already visible over 30-min blocks in both these subgroups; changes in SD were only seen in the accelerators. The number of atrial premature beats (PACs) increased before AF, most clearly in the accelerators. Spectral HRV analysis revealed no additional information. Conclusions: Changes in HR, SD, and an increased number of PACs herald AF from at least 30 min before onset, more pronounced in accelerators. Spectral HRV parameters are not useful to foresee AF onset. This has possible implications for device therapy. (C) 2003 The European Society of Cardiology. Published by Elsevier Science Ltd. All rights reserved.