Park Seung-Jung, On Young Keun, Kim June Soo, Jeong Dong Seop, Kim Wook Sung, Lee Young Tak
Department of Internal Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Department of Internal Medicine, Cardiac and Vascular Center, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
Int J Cardiol. 2014 Jul 1;174(3):579-85. doi: 10.1016/j.ijcard.2014.04.130. Epub 2014 Apr 22.
Cardiac autonomic dysfunction reportedly contributes to the AF triggering and maintenance. Heart rate turbulence (HRT) is a promising noninvasive measure of cardiac autonomic function. We investigated whether ambulatory ECG-based HRT measurement could predict in-hospital new-onset atrial fibrillation (AF) after coronary artery bypass graft (CABG) surgery.
HRT onset (TO) and slope (TO) were prospectively measured from 24-h Holter recording in 113 consecutive patients prior to CABG. Abnormal HRT was defined as at least one abnormal value in TO (> 0%) and TS (< 2.5 ms/RR).
Patients with abnormal HRT (n = 60) showed a significantly higher AF incidence (47% versus 21%, P = 0.005) and AF burden (29 ± 9 versus 7 ± 5 h, P = 0.043) than those with normal HRT (n = 53). Abnormal HRT were identified as independent predictors for the new-onset postoperative AF. During the follow-up period (12.0 ± 10.5 months), the abnormal HRT group showed a worse prognosis versus the normal HRT group regarding the AF recurrence/postoperative stroke (P = 0.018). Additionally, the postoperative AF incidence, in-hospital AF burden, and the rate of AF recurrence/postoperative stroke gradually elevated as the number of abnormal HRT values increased from 0 to 2.
Preoperative abnormal HRT was significantly associated with worse short-term (in-hospital new-onset AF) and long-term outcomes (post-discharge AF recurrence/postoperative stroke) after CABG surgery. Additional studies incorporating preventive interventions depending on the preoperative HRT results might be worthwhile in this patient group.
据报道，心脏自主神经功能障碍会导致房颤的触发和维持。心率震荡（HRT）是一种很有前景的心脏自主神经功能无创检测方法。我们研究了基于动态心电图的HRT测量能否预测冠状动脉旁路移植术（CABG）后院内新发房颤（AF）。
前瞻性地从113例连续接受CABG手术患者术前的24小时动态心电图记录中测量HRT起始（TO）和斜率（TS）。异常HRT定义为TO（>0%）和TS（<2.5 ms/RR）中至少有一个异常值。
HRT异常的患者（n = 60）房颤发生率（47%对21%，P = 0.005）和房颤负荷（29±9对7±5小时，P = 0.043）显著高于HRT正常的患者（n = 53）。异常HRT被确定为术后新发房颤的独立预测因素。在随访期（12.0±10.5个月），异常HRT组在房颤复发/术后卒中方面的预后比正常HRT组差（P = 0.018）。此外，随着异常HRT值的数量从0增加到2，术后房颤发生率、院内房颤负荷以及房颤复发/术后卒中率逐渐升高。
术前异常HRT与CABG手术后较差的短期（院内新发房颤）和长期预后（出院后房颤复发/术后卒中）显著相关。在该患者群体中，根据术前HRT结果纳入预防性干预措施的进一步研究可能是有价值的。
