Department of Medicine, University of Washington, Seattle, Washington.
Duke Clinical Research Institute, Durham, North Carolina.
J Am Coll Cardiol. 2014 Jun 24;63(24):2702-8. doi: 10.1016/j.jacc.2013.11.072. Epub 2014 Apr 16.
This study sought to determine whether circadian patterns in ventricular arrhythmias (VAs) occur in a current primary prevention defibrillator (implantable cardioverter-defibrillator [ICD]) population.
Cardiovascular events, including VAs, demonstrate biorhythmic periodicity.
We tested for deviation from the previously described occurrences of a morning peak, early morning nadir, and peak on Mondays in ICD therapies using generalized estimating equations and Student t tests. All hypothesis tests were performed in the entire cohort of patients with VAs as well as pre-specified subgroups.
Of 811 patients with an ICD, 186 subjects experienced 714 ICD therapy episodes for life-threatening VA. There was no morning (6 am to 12 pm) peak in therapies for the entire cohort or any subgroups. The overall cohort and several subgroups had a typical early morning (12 am to 6 am) nadir in therapies, with significantly less than 25% of therapies occurring during this 6-h block (all p < 0.05). A significant peak in therapies on Mondays occurred only in patients not on beta-blocker therapy (22% of events for the week, p = 0.029).
In the SCD-HeFT (Sudden Cardiac Death in Heart Failure Trial) population, the distribution of life-threatening VA failed to show a typical early morning peak or increased VA events on Mondays. A typical early morning nadir was seen in the entire cohort. An increased rate of events on Mondays was found in the subgroup of subjects not on beta-blocker therapy. These findings may indicate suppression of the neurohormonal triggers for VA by current heart failure therapy, particularly the use of beta-blockers in heart failure.
本研究旨在确定当前一级预防除颤器（植入式心律转复除颤器[ICD]）人群中是否存在室性心律失常（VA）的昼夜节律模式。
心血管事件，包括 VA，表现出生物节律周期性。
我们使用广义估计方程和学生 t 检验来测试 ICD 治疗中先前描述的早晨高峰、清晨低谷和周一高峰出现的偏差。所有假设检验均在整个 VA 患者队列以及预定义的亚组中进行。
在 811 例 ICD 患者中，186 例患者因危及生命的 VA 经历了 714 次 ICD 治疗事件。整个队列或任何亚组均无治疗的早晨（6 am 至 12 pm）高峰。整个队列和几个亚组的治疗中都有典型的清晨（12 am 至 6 am）低谷，在此 6 小时时间段内发生的治疗明显少于 25%（所有 p < 0.05）。仅在未接受β受体阻滞剂治疗的患者中，治疗周一出现明显高峰（一周内发生的事件占 22%，p = 0.029）。
在 SCD-HeFT（心力衰竭性猝死试验）人群中，危及生命的 VA 分布并未显示出典型的清晨高峰或周一 VA 事件增加。整个队列均可见典型的清晨低谷。未接受β受体阻滞剂治疗的患者亚组中发现周一事件发生率增加。这些发现可能表明当前心力衰竭治疗抑制了 VA 的神经激素触发因素，特别是心力衰竭中β受体阻滞剂的使用。
