Osaka M, Saitoh H, Sasabe N, Atarashi H, Katoh T, Hayakawa H, Cohen R J
Harvard-MIT Division of Health Sciences and Technology, Cambridge, Massachusetts, USA.
Ann Noninvasive Electrocardiol. 1996 Jan;1(1):3-11. doi: 10.1111/j.1542-474x.1996.tb00256.x.
The triggering role of the autonomic nervous system in the initiation of ventricular tachycardia has not been established. To investigate the relationship between changes in autonomic activity and the occurrence of nonsustained ventricular tachycardia (NSVT) we examined heart rate variability (HRV) during the 2-hour period preceding spontaneous episodes of NSVT. Twenty-four subjects were identified retrospectively as having had one episode of NSVT during 24-hour Holter ECC recording.
We measured the mean interval between normal heats (meanRR), the standard deviation of the intervals between beats (SD), the percentage of counts of sequential intervals between normal beats with a change of >50 ms (%RR50), the logarithms of low- and high-frequency spectral components (lnLF, lnHF) of HRV for sequential 10-minute segments preceding NSVT. The correlation dimension (CDim) of HRV was calculated similarly for sequential 20-minute segments. We assessed the significance of the time-course change of each marker over the 120-minute period prior to NSVT onset.
MeanRR (P < 0.05), lnLF (P < 0.0001), lnHF (P < 0.0001), the natural logarithm of the ratio of LF to HF (ln[LF/HF]; P < 0.05), and CDim (P < 0.05) showed significant time-course changes during that period, while SD and %RR50 did not. MeanRR, lnLF, lnHF, and CDim all decreased prior to the onset of NSVT, whereas ln(LF/HF) increased. We divided the subjects into two groups: one consisting of 12 patients with coronary artery disease; and the second group of 12 patients without known coronary artery disease. Both groups showed significant changes (P < 0.05) of CDim, lnLF, and lnHF preceding the episodes of NSVT.
Changes in the pattern of HRV prior to the onset of episodes of NSVT suggest that changes in autonomic activity may commonly play a role in the triggering of spontaneous episodes of NSVT in susceptible patients. The measured changes suggest a reduction in parasympathetic activity, perhaps in conjunction with an increase in sympathetic activity, may trigger NSVT.
自主神经系统在室性心动过速起始中的触发作用尚未明确。为研究自主神经活动变化与非持续性室性心动过速（NSVT）发生之间的关系，我们在NSVT自发发作前2小时内检测了心率变异性（HRV）。回顾性确定了24名在24小时动态心电图记录期间有一次NSVT发作的受试者。
我们测量了正常心搏之间的平均间期（meanRR）、心搏间期的标准差（SD）、正常心搏顺序间期变化>50 ms的计数百分比（%RR50）、NSVT发作前连续10分钟节段HRV的低频和高频谱成分的对数（lnLF、lnHF）。类似地，对连续20分钟节段计算HRV的关联维数（CDim）。我们评估了NSVT发作前120分钟内每个指标随时间变化的显著性。
在该时间段内，meanRR（P<0.05）、lnLF（P<0.0001）、lnHF（P<0.0001）、低频与高频之比的自然对数（ln[LF/HF]；P<0.05）和CDim（P<0.05）显示出显著的随时间变化，而SD和%RR50则没有。在NSVT发作前，meanRR、lnLF、lnHF和CDim均降低，而ln（LF/HF）升高。我们将受试者分为两组：一组由12例冠心病患者组成；第二组为12例无已知冠心病的患者。两组在NSVT发作前CDim、lnLF和lnHF均有显著变化（P<0.05）。
NSVT发作前HRV模式的变化表明，自主神经活动的改变可能通常在易感患者自发NSVT发作的触发中起作用。所测得的变化表明，副交感神经活动的降低，可能与交感神经活动的增加一起，可能触发NSVT。
