自主调节治疗可抑制心力衰竭患者定量 T 波交替，并改善 ANTHEM-HF 研究中的患者压力感受反射敏感性。
Autonomic regulation therapy suppresses quantitative T-wave alternans and improves baroreflex sensitivity in patients with heart failure enrolled in the ANTHEM-HF study.
机构信息
Cyberonics, Inc., Houston, Texas.
Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts.
出版信息
Heart Rhythm. 2016 Mar;13(3):721-8. doi: 10.1016/j.hrthm.2015.11.030. Epub 2015 Nov 18.
BACKGROUND
Autonomic regulation therapy (ART) with chronic vagus nerve stimulation improves ventricular function in patients with chronic heart failure, but its effects on quantitative T-wave alternans (TWA), ventricular tachycardia (VT), baroreflex sensitivity, and autonomic tone remained unknown.
OBJECTIVE
Effects on TWA, a marker of risk of life-threatening arrhythmias; heart rate turbulence (HRT), an indicator of baroreflex sensitivity; heart rate variability; and VT incidence were studied in 25 patients with chronic symptomatic heart failure and reduced ejection fraction enrolled in the ANTHEM-HF study (NCT01823887).
METHODS
Twenty-four-hour ambulatory electrocardiographic recordings made before ART system (Cyberonics, Inc., Houston, TX) implantation involving the left or right vagus nerve and after 6 and 12 months of chronic therapy (10-Hz frequency, 250-μs pulse width, maximum tolerable current amplitude after 10 weeks of titration) at low-intensity (<2 mA; n = 10, 40%) or high-intensity (≥2 mA; n = 15, 60%) stimulation levels were analyzed.
RESULTS
At 12 months, peak TWA levels were reduced by 29% from 71.0 ± 4.6 to 50.5 ± 1.8 μV (P < .0001). The number of patients with severely abnormal TWA (≥60 μV) was reduced by 76% from 17 to 4 (P < .0005), and the number of patients with nonsustained VT decreased by 73% from 11 to 3 (P < .025). HRT slope (P < .025), high frequency heart rate variability (HRV) (P = .05), and square root of the mean squared differences of successive normal-to-normal interval HRV (P = .013) increased. The mean heart rate derived from 24-hour Holter electrocardiograms decreased by 10% from 77 ± 2 to 69 ± 2 beats/min (P = .0002). HRT onset was unchanged.
CONCLUSION
Chronic ART in patients with symptomatic heart failure improves cardiac electrical stability, as reflected by reduced TWA levels and heart rate, suppresses VT, and increases baroreceptor sensitivity. These observations deserve study in a larger population.
背景
慢性迷走神经刺激的自主调节治疗（ART）可改善慢性心力衰竭患者的心室功能，但其对定量 T 波交替（TWA）、室性心动过速（VT）、压力反射敏感性和自主神经张力的影响尚不清楚。
目的
在 ANTHEM-HF 研究（NCT01823887）中，研究了 25 例慢性有症状心力衰竭和射血分数降低的患者的 TWA（一种危及生命的心律失常风险标志物）、心率震荡（HRT）（一种压力反射敏感性指标）、心率变异性和 VT 发生率的变化。TWA 是一种危及生命的心律失常风险标志物；HRT，一种压力反射敏感性指标；心率变异性；和 VT 发生率。方法：在 24 小时动态心电图记录之前，对 25 例慢性有症状心力衰竭和射血分数降低的患者进行了分析。患者接受了左或右迷走神经的 ART 系统（Cyberonics，Inc.，Houston，TX）植入术，并在低强度（<2 mA；n = 10，40%）或高强度（≥2 mA；n = 15，60%）刺激水平下进行了 6 和 12 个月的慢性治疗（10-Hz 频率，250-μs 脉冲宽度，在 10 周滴定后最大耐受电流幅度）。结果：在 12 个月时，峰值 TWA 水平从 71.0±4.6 降至 50.5±1.8 μV（P<0.0001）。严重 TWA 异常（≥60 μV）的患者从 17 例减少到 4 例（P<0.0005），非持续性 VT 的患者从 11 例减少到 3 例（P<0.025）。HRT 斜率（P<0.025）、高频心率变异性（HRV）（P=0.05）和连续正常到正常间期 HRV 的均方根差异（P=0.013）增加。24 小时动态心电图的平均心率从 77±2 次/分降至 69±2 次/分（P=0.0002）。HRT 起始时间无变化。结论：在有症状心力衰竭患者中，慢性 ART 可改善心脏电稳定性，表现为 TWA 水平和心率降低，抑制 VT，并增加压力感受器敏感性。这些观察结果值得在更大的人群中进行研究。
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