Wollmann C G, Gradaus R, Böcker D, Fetsch T, Hintringer F, Hoh G, Hatala R, Podczeck-Schweighofer A, Kreutzer U, Kamaryt P, Hauser T, Kersten J F, Wegscheider K, Breithardt G
Department of Internal Medicine III, University Hospital, St. Pölten, Austria. Institute of Cardiovascular Research, Karl Landsteiner Society, St. Pölten, Austria.
Physiol Meas. 2015 May;36(5):1047-61. doi: 10.1088/0967-3334/36/5/1047. Epub 2015 Apr 22.
The HAWAI registry evaluated the role of heart rate variability in predicting the occurrence of ventricular tachycardia and fibrillation (VT/VF) and sinus tachycardia in patients with an implantable cardioverter-defibrillator (45 patients with 155 RR recordings). A significant decrease of the mean value of all RR intervals (MeanNN) was observed in the period starting 20 and 40 min prior to VT/VF and sinus tachycardia, respectively. The standard deviation of RR intervals (SDNN) and the power at low frequency (LF) were the only parameters with significant changes prior to VT/VF. For sinus tachycardia, the root mean square of successive differences of all successive RR intervals (r-MSSD) and the power at low and high frequency (HF) decreased, whereas SDNN and the power at very low frequency increased. Comparison of RR recordings preceding VT/VF and sinus tachycardia revealed significant differences of the MeanNN, SDNN, r-MSSD, LF and HF. Based on a classification and regression tree analysis, MeanNN, SDNN and r-MSSD showed a sensitivity of 94.4% and a specificity of 50.6% as predictors of VT/VF. Our results suggest that the temporal changes in heart rate before an arrhythmic event can be used to predict the occurrence of VT/VF. These parameters may be used to optimize pacing therapies designed to prevent VT/VF recurrences as well as for improving device-based discriminators for VT/VF and sinus tachycardia.
HAWAI注册研究评估了心率变异性在预测植入式心脏复律除颤器患者室性心动过速和颤动（VT/VF）以及窦性心动过速发生中的作用（45例患者有155次RR间期记录）。分别在VT/VF和窦性心动过速发作前20分钟和40分钟开始的时间段内，观察到所有RR间期的平均值（MeanNN）显著下降。RR间期标准差（SDNN）和低频功率（LF）是VT/VF发作前唯一有显著变化的参数。对于窦性心动过速，所有连续RR间期的逐次差的均方根（r-MSSD）以及低频和高频功率（HF）下降，而SDNN和极低频功率增加。VT/VF和窦性心动过速发作前RR间期记录的比较显示，MeanNN、SDNN、r-MSSD、LF和HF存在显著差异。基于分类回归树分析，MeanNN、SDNN和r-MSSD作为VT/VF的预测指标，敏感性为94.4%，特异性为50.6%。我们的结果表明，心律失常事件发生前心率的时间变化可用于预测VT/VF的发生。这些参数可用于优化旨在预防VT/VF复发的起搏治疗，以及改进基于设备的VT/VF和窦性心动过速鉴别器。
