Corino Valentina D A, Ulimoen Sara R, Enger Steve, Mainardi Luca T, Tveit Arnljot, Platonov Pyotr G
Dipartimento di Elettronica, Informazione e Bioingegneria, Politecnico di Milano, Milano, Italy.
J Cardiovasc Electrophysiol. 2015 Feb;26(2):137-41. doi: 10.1111/jce.12580. Epub 2014 Dec 2.
Irregularity measures have been suggested as risk indicators in patients with atrial fibrillation (AF); however, it is not known to what extent they are affected by commonly used rate-control drugs. We aimed at evaluating the effect of metoprolol, carvedilol, diltiazem, and verapamil on the variability and irregularity of the ventricular response in patients with permanent AF.
Sixty patients with permanent AF were part of an investigator-blind cross-over study, comparing 4 rate-control drugs (diltiazem, verapamil, metoprolol, and carvedilol). We analyzed five 20-minute segments per patient: baseline and the 4 drug regimens. On every segment, heart rate (HR) variability and irregularity of RR series were computed. The variability was assessed as standard deviation, pNN20, pNN50, pNN80, and rMSSD. The irregularity was assessed by regularity index, approximate (ApEn), and sample entropy. A significantly lower HR was obtained with all drugs, the HR was lowest using the calcium channel blockers. All drugs increased the variability of ventricular response in respect to baseline (as an example, rMSSD: baseline 171 ± 47 milliseconds, carvedilol 229 ± 58 milliseconds; P < 0.05 vs. baseline, metoprolol 226 ± 66 milliseconds; P < 0.05 vs. baseline, verapamil 228 ± 84; P < 0.05 vs. baseline, diltiazem 256 ± 87 milliseconds; P < 0.05 vs. baseline and all other drugs). Only β-blockers significantly increased the irregularity of the RR series (as an example, ApEn: baseline 1.86 ± 0.13, carvedilol 1.92 ± 0.09; P < 0.05 vs. baseline, metoprolol 1.93 ± 0.08; P < 0.05 vs. baseline, verapamil 1.86 ± 0.22 ns, diltiazem 1.88 ± 0.16 ns).
Modification of AV node conduction by rate-control drugs increase RR variability, while only β-blockers affect irregularity.
不规则性测量已被提议作为心房颤动（AF）患者的风险指标；然而，尚不清楚它们在多大程度上受到常用心率控制药物的影响。我们旨在评估美托洛尔、卡维地洛、地尔硫䓬和维拉帕米对永久性AF患者心室反应变异性和不规则性的影响。
60例永久性AF患者参与了一项研究者盲法交叉研究，比较4种心率控制药物（地尔硫䓬、维拉帕米、美托洛尔和卡维地洛）。我们分析了每位患者的五个20分钟时段：基线期和4种药物治疗期。在每个时段，计算心率（HR）变异性和RR间期序列的不规则性。变异性通过标准差、pNN20、pNN50、pNN80和rMSSD进行评估。不规则性通过规则性指数、近似熵（ApEn）和样本熵进行评估。所有药物均使HR显著降低，使用钙通道阻滞剂时HR最低。所有药物均使心室反应的变异性相对于基线期增加（例如，rMSSD：基线期171±47毫秒，卡维地洛229±58毫秒；与基线期相比P<0.05，美托洛尔226±66毫秒；与基线期相比P<0.05，维拉帕米228±84；与基线期相比P<0.05，地尔硫䓬256±87毫秒；与基线期及所有其他药物相比P<0.05）。只有β受体阻滞剂显著增加了RR间期序列的不规则性（例如，ApEn：基线期1.86±0.13，卡维地洛1.92±0.09；与基线期相比P<0.05，美托洛尔1.93±0.08；与基线期相比P<0.05，维拉帕米1.86±0.22无显著性差异，地尔硫䓬1.88±0.16无显著性差异）。
心率控制药物对房室结传导的改变增加了RR变异性，而只有β受体阻滞剂影响不规则性。
