Wolpert C, Jung W, Spehl S, Korte T, Lüderitz B
Medizinische Universitätsklinik und Poliklinik, Sigmund-Freud-Strasse 25, 53105, Bonn.
Herzschrittmacherther Elektrophysiol. 1997 Mar;8(1):46-52. doi: 10.1007/BF03042477.
For the acute myocardial infarction and sudden cardiac death a circadian variation can be observed. There are several, mostly epidemiological studies that demonstrate this non-uniform distribution of events in different day-time periods. These studies are in the vast majority based on eye-witness reports, medical documents and retrospective evaluation of the timing of the event. Moreover, they represent only singular observations in a heterogeneous population. With the introduction of implantable cardioverter-defibrillators which provide extensive diagnostic features such as stored RR-intervals, endocardial electrograms of each episode and internal time storage, an exact analysis of the circadian variation of malignant ventricular tachyarrhythmias became feasible. Ventricular tachyarrhythmias follow a different circadian distribution with increased number of events at certain day-time periods. For patients with a coronary artery disease a significantly higher risk to experience a potentially fatal arrhythmia could be shown for the mid-morning hours and a secondary peak occurrence for the late afternoon and the early evening. Patients with idiopathic dilated cardiomyopathy tend to have a higher probability of events in the evening hours. With respect to beta-blockers and other antiarrhythmic drugs most of the studies failed to confirm a blunting influence on the degree of variability for fast arrhythmias. Others showed similar patterns for fast and slow tachycardias. Another clinical parameter, the degree of congestive heart failure was in some studies found to influence the pattern in the sense of causing a distinct difference in occurrence frequency. A higher vairation was determined for lower NYHA classes < III. Other studies were contrary to these findings. The activity level before the onset of arrhythmias has yet been only insufficiently analyzed regarding the day-time-variability. But first results make believe, that patients younger than 50 years and still involved in the working process seem to follow a more varying circadian distribution. More substudies will have to be performed to compare working and nonworking patients and patients with different structural heart diseases. Furthermore ther influence of antiarrhythmic agents on the day-time-variation of ventricular tachyarrhythmias should be assessed. Finally, there, should be systematic prospective studies that evaluate the influence of drug administration on triggers of ventricular tachyarrhythmias such as sympathoadrenergic activity, premature ventricular beats, reduction of heart rate variability and others with respect to their day-time-variability.
对于急性心肌梗死和心源性猝死，可以观察到昼夜节律变化。有几项主要是流行病学的研究表明了这些事件在不同时间段的非均匀分布。这些研究绝大多数基于目击者报告、医疗文件以及对事件发生时间的回顾性评估。此外，它们仅代表异质人群中的单一观察结果。随着可植入式心脏复律除颤器的引入，其提供了诸如存储的RR间期、每次发作的心内膜电图和内部时间存储等广泛的诊断特征，对恶性室性心律失常的昼夜节律变化进行精确分析变得可行。室性心律失常遵循不同的昼夜分布，在某些白天时间段事件数量增加。对于冠心病患者，上午中段时间发生潜在致命性心律失常的风险显著更高，下午晚些时候和傍晚出现二次高峰。特发性扩张型心肌病患者在傍晚时分发生事件的可能性往往更高。关于β受体阻滞剂和其他抗心律失常药物，大多数研究未能证实对快速心律失常变异性程度有钝化作用。其他研究表明快速和缓慢室性心动过速有相似模式。另一个临床参数，充血性心力衰竭程度，在一些研究中发现会影响模式，导致发生频率有明显差异。纽约心脏协会（NYHA）分级<III级的患者变异性更高。其他研究与这些发现相反。关于心律失常发作前的活动水平，其昼夜变异性尚未得到充分分析。但初步结果让人相信，年龄小于50岁且仍在工作的患者似乎遵循更具变化性的昼夜分布。需要进行更多的亚研究来比较工作和非工作患者以及患有不同结构性心脏病的患者。此外，应评估抗心律失常药物对室性心律失常昼夜变异性的影响。最后，应该有系统的前瞻性研究来评估药物给药对室性心律失常触发因素的影响，如交感神经活性、室性早搏、心率变异性降低等，以及它们的昼夜变异性。
