Seaborn Geoffrey E J, Todd Keith, Michael Kevin A, Baranchuk Adrian, Abdollah Hoshiar, Simpson Christopher S, Akl Selim G, Redfearn Damian P
Division of Cardiology (Arrhythmia Service), Kingston General Hospital, Queen's University, Kingston, Ontario, Canada.
Ann Noninvasive Electrocardiol. 2014 Jan;19(1):23-33. doi: 10.1111/anec.12098. Epub 2013 Sep 24.
In patients with normal hearts, increased vagal tone is associated with onset of paroxysmal atrial fibrillation (AF). Vagal denervation of the atria renders AF less inducible. Circumferential pulmonary vein isolation (CPVI) is effective for treating paroxysmal and persistent AF, and has been shown to impact heart rate variability (HRV) indices, in turn, reflecting vagal denervation. We examined the impact of CPVI on HRV indices, and evaluated the relationship between vagal modification and AF recurrence.
Electrocardiogram recordings were collected from 83 consecutive patients (63 male, 20 female, age 56.9 ± 9.3 years) undergoing CPVI for paroxysmal (n = 56) or persistent (n = 27) AF. Recordings were obtained over 10 minutes preprocedure, and at intervals up to 12 months. Antiarrhythmic medications were suspended prior to CPVI, and were resumed for 3 months following. Success was defined as no recurrence of atrial arrhythmia lasting longer than 30 seconds.
In patients with successful procedures (n = 56, 42 paroxysmal, 14 persistent), HRV indices were significantly altered, with respect to preprocedure levels, over a sustained period. However, patients with recurrence (n = 27, 14 paroxysmal, 13 persistent) demonstrated similar HRV to their preprocedure levels over the follow-up period.
Our results suggest that patients experiencing recurrence after a single CPVI have HRV attenuated by the procedure only intermittently, whereas patients with one successful CPVI experience a sustained change. A short-term HRV recording is a convenient and potentially important marker for recurrence of atrial arrhythmia in a population undergoing CPVI.
在心脏正常的患者中，迷走神经张力增加与阵发性心房颤动（AF）的发作有关。心房的迷走神经去神经支配使房颤更不易诱发。环肺静脉隔离（CPVI）对治疗阵发性和持续性房颤有效，并且已被证明会影响心率变异性（HRV）指标，进而反映迷走神经去神经支配情况。我们研究了CPVI对HRV指标的影响，并评估了迷走神经调节与房颤复发之间的关系。
连续收集了83例接受CPVI治疗阵发性（n = 56）或持续性（n = 27）房颤的患者（63例男性，20例女性，年龄56.9±9.3岁）的心电图记录。在术前10分钟以及长达12个月的间隔时间内进行记录。在CPVI之前停用抗心律失常药物，并在之后3个月恢复使用。成功定义为持续时间超过30秒的房性心律失常无复发。
在手术成功的患者（n = 56，42例阵发性，14例持续性）中，HRV指标相对于术前水平在一段持续时间内有显著改变。然而，复发的患者（n = 27，14例阵发性，13例持续性）在随访期间的HRV与术前水平相似。
我们的结果表明，单次CPVI后复发的患者其HRV仅间歇性地因手术而减弱，而单次CPVI成功的患者则经历持续变化。短期HRV记录是接受CPVI人群中心房心律失常复发的一种方便且可能重要的标志物。
