Tokuyama Takehito, Nakano Yukiko, Awazu Akinori, Uchimura-Makita Yuko, Fujiwra Mai, Watanabe Yoshikazu, Sairaku Akinori, Kajihara Kenta, Motoda Chikaaki, Oda Noboru, Kihara Yasuki
Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.
Department of Cardiovascular Medicine, Hiroshima University Graduate School of Biomedical and Health Sciences, Hiroshima, Japan.
J Cardiol. 2014 Aug;64(2):133-8. doi: 10.1016/j.jjcc.2013.12.001. Epub 2014 Feb 1.
Abnormal sympathetic innervation triggers ventricular fibrillation (VF). We examined the circadian variation of autonomic nervous system and its relevance to risk stratification of VF in patients with Brugada syndrome (Brs).
We enrolled 12 male Brs patients with documented VF (Brs-S; mean age, 42±4 years), 17 without documented VF (Brs-N; mean age 48±4 years), and 16 age- and gender-matched controls. The clinical data, 12-lead electrocardiography (ECG), signal-averaged ECG, electrophysiological study (EPS), and heart rate variability from 24h Holter ECG were compared between the groups.
The low frequency components (LF) in Brs-S and Brs-N and high frequency components (HF) in Brs-S patients were significantly lower than in the controls (409.8±128.6ms(2), 329.5±108ms(2) vs. 945.3±111.3ms(2); 135.1±73.8ms(2) vs. 391.8±63.9ms(2), respectively). The circadian variation of the LF and LF/HF decreased in the Brs patients, the standard deviation (SD) of LF/HF (<2.5) and SD of LF (<400ms(2)) had sufficiently high sensitivity (96.6%) and specificity (92.9%) for the diagnosis of Brs. Most of the Brs-S patients (83.3%) were located under the line formed by the SD/mean of HF=SD/mean of LF in the scatter plots.
Lack of the circadian variation of autonomic function occurs in Brs, and this may contribute to the pathogenesis of VF.
异常的交感神经支配会引发心室颤动（VF）。我们研究了自主神经系统的昼夜变化及其与 Brugada 综合征（Brs）患者 VF 风险分层的相关性。
我们纳入了 12 例有记录的 VF 的男性 Brs 患者（Brs-S；平均年龄，42±4 岁），17 例无记录的 VF 的患者（Brs-N；平均年龄 48±4 岁），以及 16 例年龄和性别匹配的对照组。比较了各组之间的临床数据、12 导联心电图（ECG）、信号平均心电图、电生理研究（EPS）以及 24 小时动态心电图的心率变异性。
Brs-S 和 Brs-N 患者的低频成分（LF）以及 Brs-S 患者的高频成分（HF）均显著低于对照组（分别为 409.8±128.6ms²、329.5±108ms² 与 945.3±111.3ms²；135.1±73.8ms² 与 391.8±63.9ms²）。Brs 患者中 LF 和 LF/HF 的昼夜变化减小，LF/HF 的标准差（SD）（<2.5）和 LF 的 SD（<400ms²）对 Brs 的诊断具有足够高的敏感性（96.6%）和特异性（92.9%）。在散点图中，大多数 Brs-S 患者（83.3%）位于 HF 的 SD/平均值 = LF 的 SD/平均值所形成的线以下。
Brs 患者存在自主神经功能昼夜变化缺失的情况，这可能有助于 VF 的发病机制。
