心脏复律后心率变异性与心房颤动复发

Heart rate variability and recurrence of atrial fibrillation after electrical cardioversion.

作者信息

Vikman Saila, Mäkikallio Timo H, Yli-Mäyry Sinikka, Nurmi Marita, Airaksinen K E Juhani, Huikuri Heikki V

机构信息

Division of Cardiology, Department of Medicine, University Hospital of Tampere, University of Tampere, Finland.

出版信息

Ann Med. 2003;35(1):36-42. doi: 10.1080/07853890310004110.

DOI:10.1080/07853890310004110

PMID:12693611

Abstract

BACKGROUND

Heart rate (HR) variability has been shown to predict spontaneous onset of atrial fibrillation (AF). This study was designed to test the hypothesis that HR variability after electrical cardioversion (CV) of persistent AF predicts the recurrence of AF.

METHODS

Various time and frequency domain measures of HR variability, along with the non-linear measures of HR dynamics, were analyzed from the 24-hour ECG recordings in 78 patients with persistent AF after restoration of sinus rhythm with electrical CV.

RESULTS

During the follow-up of one month, 27 patients (35%) had recurrence of AF. The patients with AF recurrence had significantly higher standard deviation of all R-R intervals (SDNN 117 +/- 34 versus 100 +/- 29 P < 0.05), increased high-frequency (InHF 5.7 +/- 0.6 versus 5.3 +/- 0.7 P < 0.05 ), low-frequency (InLF 6.2 +/- 0.8 versus 5.6 +/- 0.9 P < 0.01) and very-low-frequency (InVLF 7.1 +/- 0.8 versus 6.5 +/- 0.8 P < 0.01) power spectral components of HR variability than those who remained in sinus rhythm. Approximate entropy, a measure of complexity of HR dynamics, and the short-term fractal scaling exponent did not differ between the groups, but the long-term power-law slope beta was steeper among the patients who remained in sinus rhythm (P < 0.05). During the first week after the CV, increased HF power (highest tertile) was the most powerful predictor of AF recurrence with odds ratio of 2.8 (95% confidence interval 1.0 to 8.0, P < 0.05). Increased VLF power spectral component at baseline predicted best the late recurrence of AF with odds ratio of 3.3 (95% confidence interval 1.6 to 7.2, P < 0.01). No clinical or echocardiographic variable predicted the recurrence of AF.

CONCLUSIONS

Increased HR variability in all major power spectral bands is associated with late recurrence of AF after electrical CV. Enhanced cardiac vagal outflow, reflected as an increased HF power spectral component, seems to predict specifically the early recurrence of AF after the CV.

摘要

背景

心率（HR）变异性已被证明可预测房颤（AF）的自发发作。本研究旨在检验持续性房颤电复律（CV）后HR变异性可预测房颤复发的假设。

方法

对78例持续性房颤患者在电复律恢复窦性心律后24小时心电图记录中的HR变异性的各种时域和频域测量指标，以及HR动态的非线性测量指标进行分析。

结果

在1个月的随访期间，27例患者（35%）发生房颤复发。房颤复发患者的所有R-R间期标准差（SDNN 117±34对100±29，P<0.05）、高频（InHF 5.7±0.6对5.3±0.7，P<0.05）、低频（InLF 6.2±0.8对5.6±0.9，P<0.01）和极低频（InVLF 7.1±0.8对6.5±0.8，P<0.01）功率谱成分均显著高于维持窦性心律的患者。HR动态复杂性的测量指标近似熵和短期分形标度指数在两组间无差异，但维持窦性心律的患者的长期幂律斜率β更陡（P<0.05）。在电复律后的第一周，高频功率增加（最高三分位数）是房颤复发的最强预测因子，比值比为2.8（95%置信区间1.0至8.0，P<0.05）。基线时极低频功率谱成分增加对房颤晚期复发的预测最佳，比值比为3.3（95%置信区间1.6至7.2，P<0.01）。没有临床或超声心动图变量可预测房颤复发。