Makarov Leonid, Komoliatova Vera, Zevald Svetlana, Schmidt George, Muller Capital A Cyrilliclexander, Serebruany Victor
Center for Syncope and Cardiac Arrhythmias in Children and Adolescents of the Federal Medical-biological Agency of Russia, Children's Clinical Hospital No. 38 of FMBA of Russia, Moscow, Russia.
J Electrocardiol. 2010 Jan-Feb;43(1):8-14. doi: 10.1016/j.jelectrocard.2009.11.001.
Twenty-four hour ambulatory electrocardiogram (AECG) monitoring is an established technique for integrated assessment of heart rhythm; however, comprehensive description of serial changes in cardiac electrophysiology over the first days of life in humans is lacking. The aim of this study was to determine the patterns of circadian heart rhythm based on AECG evaluation in newborns.
Twenty healthy newborns (14 boys and 6 girls) were serially examined with AECG at days 1, 2, and 4 after birth. Heart rate (HR), arrhythmias, QT dynamicity, microvolt T-wave alternans, and various indices of HR variability (HRV) including deceleration/acceleration capacity analysis were analyzed.
There were no sex differences in HR. Supraventricular premature beats were noted in 35%, ventricular-in 15 % of newborns. Slope QT/RR was 0.35 (0.3-0.5); intercept QT/RR was 124 (93-148), QT/RR correlation coefficient (r) was 0.63 (0.53-0.85). Peak value of T-wave alternans was 32 +/- 8 (12-55) muV. Low level of HRV was typical for all parameters of time-domain analysis compared with normal limits for older children. The overall mean values of deceleration/acceleration capacity were 3.38 +/- 0.57 (2.16-4.13) and -3.58 +/- 0.67 (-2.13 to -4.38) milliseconds, respectively.
The healthy newborns exhibit peculiarities of 24-hour cardiac rhythm with isolated premature beats, pauses of sinus rhythm less 1000 milliseconds, steep slope of QT/RR by analysis of QT dynamicity. There are low HRV, and symmetrical AC/DC capacity was typically for autonomic regulation of HR, probably due to high sympathetic activity at this age.
24小时动态心电图(AECG)监测是一种用于综合评估心律的成熟技术;然而,目前缺乏对人类出生后最初几天心脏电生理系列变化的全面描述。本研究的目的是基于对新生儿的AECG评估来确定昼夜心律模式。
对20名健康新生儿(14名男孩和6名女孩)在出生后第1天、第2天和第4天进行连续的AECG检查。分析心率(HR)、心律失常、QT动态变化、微伏T波交替以及包括减速/加速能力分析在内的各种心率变异性(HRV)指标。
HR无性别差异。35%的新生儿出现室上性早搏,15%出现室性早搏。QT/RR斜率为0.35(0.3 - 0.5);QT/RR截距为124(93 - 148),QT/RR相关系数(r)为0.63(0.53 - 0.85)。T波交替的峰值为32±8(12 - 55)微伏。与大龄儿童的正常范围相比,时域分析的所有参数的HRV水平均较低。减速/加速能力的总体平均值分别为3.38±0.57(2.16 - 4.13)和 - 3.58±0.67( - 2.13至 - 4.38)毫秒。
健康新生儿表现出24小时心律的特点,有孤立性早搏、窦性心律停顿小于1000毫秒、通过QT动态分析显示QT/RR斜率较陡。HRV较低,且HR的自主调节通常具有对称的AC/DC能力,这可能是由于该年龄段交感神经活动较高所致。