Deguchi Yoshiaki, Amino Mari, Adachi Kumiko, Matsuzaki Atsushi, Iwata Osamu, Yoshioka Koichiro, Watanabe Eiichi, Tanabe Teruhisa
Department of Cardiology, Internal Medicine, School of Medicine, Tokai University, Isehara, Japan.
Ann Noninvasive Electrocardiol. 2009 Jul;14(3):280-9. doi: 10.1111/j.1542-474X.2009.00311.x.
This study aimed to compare the circadian distribution of the onset, maintenance and termination of paroxysmal atrial fibrillation (PAF) between structural and non-structural heart diseases (SHD and NSHD, respectively) in the untreated state.
We included 217 patients with 338 PAF (79 SHD patients with 131 episodes; 138 NSHD patients with 207 episodes). The probabilities for the onset, maintenance and termination of PAF for each hour were analyzed using Holter monitoring data and harmonic models being fitted into a cosinusoidal function.
The SHD group had a triphasic circadian pattern at the onset with higher peaks at midnight, in the early morning and in the late afternoon (p < 0.05), whereas the NSHD group showed a single peak at midnight (p < 0.01). The probability of maintenance revealed a single peak during midnight (SHD, p < 0.0001; NHD, p < 0.01). The termination showed a peak at noon in the SHD group (p < 0.05), whereas there was a double peak at 10:00 am and 8:00 pm in the NSHD group (p=0.06). RR intervals just after the PAF onset showed marked shortening in the daytime initiation PAF as compared to the nighttime initiation PAF in both SHD and NSHD groups (p < 0.01).
These observations suggest that the SHD group has very complex onset hours, whereas the NSHD group shows complex termination hours. Reflexly accelerated sympathetic tone just after the PAF onset is suggested in the daytime initiation PAF.
本研究旨在比较未经治疗状态下，结构性心脏病和非结构性心脏病（分别为SHD和NSHD）患者阵发性心房颤动（PAF）发作、持续和终止的昼夜分布情况。
我们纳入了217例患者，共338次PAF发作（79例SHD患者发作131次；138例NSHD患者发作207次）。利用动态心电图监测数据和拟合为余弦函数的谐波模型分析每小时PAF发作、持续和终止的概率。
SHD组在发作时呈现三相昼夜节律模式，午夜、清晨和傍晚出现较高峰值（p < 0.05），而NSHD组仅在午夜出现一个峰值（p < 0.01）。持续概率在午夜出现一个峰值（SHD，p < 0.0001；NSHD，p < 0.01）。终止在SHD组中午出现一个峰值（p < 0.05），而NSHD组在上午10:00和晚上8:00出现双峰（p = 0.06）。在SHD组和NSHD组中，与夜间发作PAF相比，白天发作PAF发作后即刻的RR间期明显缩短（p < 0.01）。
这些观察结果表明，SHD组发作时间非常复杂，而NSHD组终止时间复杂。提示白天发作PAF时，PAF发作后即刻交感神经张力反射性加快。
