Department of Cardiology, Renmin Hospital of Wuhan University and Cardiovascular Research Institute of Wuhan University, 238 Jiefang Road, Wuchang 430060, Wuhan, People's Republic of China.
Clin Res Cardiol. 2013 May;102(5):361-70. doi: 10.1007/s00392-013-0545-6. Epub 2013 Feb 6.
To investigate autonomic involvement in different types of idiopathic premature ventricular contractions (PVCs) grouped by heart rate (HR) dependency.
One hundred and sixty PVC patients and 31 controls were enrolled. Holter ECG was used to evaluate PVC occurrence, and spectral analysis of heart rate variability (HRV) was calculated to represent cardiac autonomic control. PVCs were divided into fast rate-dependent (F-PVC), slow rate-dependent (S-PVC), and HR-independent PVC (I-PVC) based on the relationship between hourly PVC density and hourly HR. HRV among different types of PVCs were compared, and the association between PVC density with HR and HRV were analyzed. Furthermore, autonomic changes assessed by consecutive 5-min HRV in 30 min before PVC episodes were investigated.
In 160 subjects, there were 73 F-PVC, 56 S-PVC, and 31 I-PVC. Hourly PVC density was positively associated with sympathetic indice (LF/HF) and negatively related to vagal indices (HF and HFnu) in F-PVC, and this trend was reversed in S-PVC. During 30 min before PVC onset, RR interval and HFnu decreased significantly with LF/HF showing an increasing trend in F-PVC, while in S-PVC both RR interval and HF increased significantly. It was noted that those changes were most evident during the last 5 min before PVC onset. In addition, PVC density in F-PVC was significantly decreased by β-blocker treatment.
HR dependency reflected autonomic modulation of idiopathic PVCs. F-PVC and S-PVC might be facilitated by sympathetic activation and vagal activation, respectively. HR dependency and the related autonomic mechanisms should be considered when treating idiopathic PVCs.
研究根据心率（HR）依赖性分组的不同类型特发性室性早搏（PVC）的自主神经参与情况。
纳入 160 例 PVC 患者和 31 例对照者。使用动态心电图评估 PVC 发生情况，并计算心率变异性（HRV）的频谱分析以代表心脏自主神经控制。根据每小时 PVC 密度与每小时 HR 之间的关系，将 PVC 分为快心率依赖性（F-PVC）、慢心率依赖性（S-PVC）和 HR 独立型 PVC（I-PVC）。比较不同类型 PVC 之间的 HRV，并分析 PVC 密度与 HR 和 HRV 的关系。此外，还研究了 PVC 发作前 30 分钟内连续 5 分钟 HRV 评估的自主神经变化。
在 160 例患者中，有 73 例 F-PVC、56 例 S-PVC 和 31 例 I-PVC。F-PVC 中每小时 PVC 密度与交感神经指标（LF/HF）呈正相关，与迷走神经指标（HF 和 HFnu）呈负相关，而在 S-PVC 中则相反。在 PVC 发作前 30 分钟内，RR 间期和 HFnu 明显下降，LF/HF 呈上升趋势，而在 S-PVC 中 RR 间期和 HF 明显升高。值得注意的是，这些变化在 PVC 发作前的最后 5 分钟最为明显。此外，F-PVC 中的 PVC 密度在β受体阻滞剂治疗后明显降低。
HR 依赖性反映了特发性 PVC 的自主神经调节。F-PVC 和 S-PVC 可能分别由交感神经激活和迷走神经激活促进。在治疗特发性 PVC 时，应考虑 HR 依赖性和相关的自主神经机制。
