Coumel P
Hôpital Lariboisière, Paris, France.
G Ital Cardiol. 1992 May;22(5):647-54.
The autonomic nervous system plays an important role in the genesis of cardiac arrhythmias but the precise definition of this role is quite complex. The fluctuations of the heart rate may provide useful information about the balance of the autonomic nervous system. However, one obvious limitation is represented by extrapolating to the ventricle events which occur at the sinus node level. It has been clearly documented that atrial fibrillation of vagal origin is preceded by a progressive decrease in heart rate. On the other hand, ventricular arrhythmias of adrenergic origin are preceded by progressive heart rate acceleration and by diminution of vagally mediated short term changes. The absolute value in heart rate is less important than the actual trend in allowing inferences on the relative sympathetic or vagal predominance. A better understanding of the changes in the autonomic balance will provide a key for the mechanisms underlying several clinical events.
自主神经系统在心律失常的发生中起重要作用，但该作用的确切定义相当复杂。心率波动可能提供有关自主神经系统平衡的有用信息。然而，一个明显的局限性是将窦房结水平发生的事件外推到心室。已有明确记录表明，迷走神经源性房颤之前心率会逐渐下降。另一方面，肾上腺素能源性室性心律失常之前心率会逐渐加快，且迷走神经介导的短期变化会减少。在推断交感神经或迷走神经相对优势时，心率的绝对值不如实际趋势重要。更好地理解自主神经平衡的变化将为若干临床事件背后的机制提供关键线索。
