Mameli P, Giraudi D, Virdis A, Manconi A M, Tilocca P, Marini S, Maioli M
Cattedra di Semeiotica Cardiovascolare, Università di Sassari.
Boll Soc Ital Biol Sper. 1990 Jun;66(6):513-9.
In 26 patients (65-80 yr) with low risk of sudden death, the circadian rhythm of spontaneous ventricular arrhythmias was analyzed, throughout 72 h, by the Holter monitoring method. The prolonged ECG monitoring is indispensable to evaluate the real necessity of an antiarrhythmic therapy and to establish the therapeutic approach. Premature ventricular complexes (PVC): isolated, couplets and runs of ventricular tachycardia have been considered. The isolated PVC showed uniform distribution throughout 24h, with higher frequency/hour ratio (f/h) in females. Couplets and runs showed circadian diurnal distribution with higher f/h ratio in smokers and males. After analysis of the results, the patients were additionally subdivided into smokers and non-smokers. Since smokers showed a diurnal distribution of all kinds of arrhythmias, antiarrhythmic drugs whose pharmacological peak corresponds to the distribution peaks of arrhythmias were proposed. Non-smokers could be divided into two groups: a) patients with isolated extrasystoles which did not show a circadian rhythm of arrhythmias and who must be treated with retard-drugs, which give protection throughout 24h; b) patients with runs or couplets of PVC showing a circadian rhythm of arrhythmias and who must be treated with drugs whose pharmacological peak corresponds to the distribution peaks of arrhythmias.
采用动态心电图监测方法，对26例（65 - 80岁）猝死低风险患者72小时内的自发性室性心律失常昼夜节律进行了分析。延长心电图监测对于评估抗心律失常治疗的实际必要性以及确定治疗方法不可或缺。已对室性早搏（PVC）：孤立性、成对及室性心动过速发作进行了研究。孤立性PVC在24小时内分布均匀，女性的每小时发作频率/小时比（f/h）更高。成对及发作性室性心动过速呈昼夜分布，吸烟者和男性的f/h比更高。在对结果进行分析后，患者被进一步分为吸烟者和非吸烟者。由于吸烟者各类心律失常呈昼夜分布，因此建议使用药理学峰值与心律失常分布峰值相对应的抗心律失常药物。非吸烟者可分为两组：a）孤立性早搏患者，其心律失常无昼夜节律，必须使用缓释药物治疗，此类药物可提供24小时的保护；b）PVC成对或发作性患者，其心律失常呈昼夜节律，必须使用药理学峰值与心律失常分布峰值相对应的药物治疗。
