Dweck Marc R, Lang Christopher C, Neilson James M M, Flapan Andrew D
Department of Cardiology, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, UK.
J Electrocardiol. 2006 Jul;39(3):324-30. doi: 10.1016/j.jelectrocard.2005.10.006. Epub 2006 Feb 28.
Sudden arousal has been associated with sudden cardiac death in individuals with ischemic heart disease, cardiac arrhythmias, and the congenital long QT syndrome. This study aimed to determine the effects of arousal on ventricular repolarization in normal individuals by examining the dynamic QT interval-heart rate relationship and T-wave morphology changes under various "arousal" scenarios.
Eighteen healthy subjects (6 women and 12 men; median age, 22 years) underwent 4 separate 24-hour electrocardiogram recordings using 2-channel Holter recorders. The protocol contained 5 different arousal events: (1) natural waking (woke naturally, then stood up), (2) morning alarm (woken by alarm in the morning, then stood up); (3) night alarm (woken by alarm during the night, then stood up), (4) morning alarm-remain lying (woken by alarm in the morning but remained supine), and (5) lying to standing (stood up from a supine position during the day). Holter recordings were analyzed using a commercial package for dynamic assessment of the QT/RR relationship.
In the 20 minutes after arousal, no changes were seen in overall QT/RR relationship in any of the groups. However, marked T-wave morphology changes, including T-wave inversion, were observed in all the arousal events. Postural changes only accounted for a small proportion of change in T-wave morphology.
In healthy subjects, noxious arousal causes marked changes in the morphology of the T wave. This may reflect abnormal adaptation of repolarization to sudden changes in heart rate and autonomic tone.
在患有缺血性心脏病、心律失常和先天性长QT综合征的个体中，突然觉醒与心脏性猝死有关。本研究旨在通过检查各种“觉醒”情况下动态QT间期与心率的关系以及T波形态变化，确定觉醒对正常个体心室复极的影响。
18名健康受试者（6名女性和12名男性；中位年龄22岁）使用双通道动态心电图记录仪进行了4次单独的24小时心电图记录。方案包含5种不同的觉醒事件：（1）自然醒来（自然醒来，然后站立），（2）早晨闹钟（早晨被闹钟叫醒，然后站立）；（3）夜间闹钟（夜间被闹钟叫醒，然后站立），（4）早晨闹钟-保持卧位（早晨被闹钟叫醒但保持仰卧位），以及（5）卧位到站立（白天从仰卧位站立）。使用商业软件包对动态心电图记录进行分析，以动态评估QT/RR关系。
在觉醒后的20分钟内，任何一组的总体QT/RR关系均未出现变化。然而，在所有觉醒事件中均观察到明显的T波形态变化，包括T波倒置。体位变化仅占T波形态变化的一小部分。
在健康受试者中，有害觉醒会导致T波形态发生明显变化。这可能反映了复极对心率和自主神经张力突然变化的异常适应。
