Simantirakis E N, Papakonstantinou P E, Chlouverakis G I, Kanoupakis E M, Mavrakis H E, Kallergis E M, Arkolaki E G, Vardas P E
Department of Cardiology, University Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Crete, Greece.
Department of Cardiology, University Hospital of Heraklion, School of Medicine, University of Crete, Heraklion, Crete, Greece.
Int J Cardiol. 2017 Mar 15;231:125-130. doi: 10.1016/j.ijcard.2016.12.025. Epub 2016 Dec 21.
The presentation of atrial fibrillation (AF) varies remarkably, from totally asymptomatic to symptomatic patients, while the same individual may present symptomatic and asymptomatic episodes. We aimed to identify electrocardiographic differences between symptomatic and asymptomatic episodes and to find parameters related to the appearance of symptoms.
Thirty consecutive patients (age 66.9±10years) with paroxysmal AF received an implantable loop recorder. Three types of episodes were defined: asymptomatic (ASx), symptomatic (Sx), and mixed asymptomatic-symptomatic (AS-Sx). The heart rate (HR) and heart rate variability (HRV) were recorded during the first 2min of each ASx or Sx episode, and during the first 2min of both the symptomatic and asymptomatic periods in AS-Sx.
Eighty-two episodes from twenty-five patients were evaluated. Mean HR was 142.48±25.84bpm for Sx and 95.71±19.29bpm for ASx (p<0.001). Mean HRV was 92.62±42.29ms for Sx and 150.06±49.68ms for ASx (p<0.001). In AS-Sx, mean HR was 102.91±24.54bpm for the asymptomatic and 141.88±23.43bpm for the symptomatic period (p<0.001). Mean HRV was 173.55±61.30ms for the asymptomatic and 87.33±30.65ms for the symptomatic period (p=0.003). There were no significant correlations between patients' characteristics and the clinical presentation of the arrhythmia.
The ASx were characterized by a lower HR and higher HRV compared to Sx. In As-Sx, the asymptomatic period was characterized by a lower HR and higher HRV compared to the symptomatic. These findings suggest a possible contribution of variations in the autonomic nervous system activity to the perception of the arrhythmia.
心房颤动（AF）的表现差异显著，从完全无症状到有症状，同一个体可能出现有症状和无症状发作。我们旨在确定有症状和无症状发作之间的心电图差异，并找出与症状出现相关的参数。
连续30例阵发性AF患者（年龄66.9±10岁）植入植入式环形记录仪。定义了三种发作类型：无症状（ASx）、有症状（Sx）和无症状-有症状混合（AS-Sx）。在每个ASx或Sx发作的前2分钟以及AS-Sx中有症状和无症状期的前2分钟记录心率（HR）和心率变异性（HRV）。
评估了25例患者的82次发作。Sx的平均HR为142.48±25.84次/分，ASx为95.71±19.29次/分（p<0.001）。Sx的平均HRV为92.62±42.29毫秒，ASx为150.06±49.68毫秒（p<0.001）。在AS-Sx中，无症状期的平均HR为102.91±24.54次/分，有症状期为141.88±23.43次/分（p<0.001）。无症状期的平均HRV为173.55±61.30毫秒，有症状期为87.33±30.65毫秒（p=0.003）。患者特征与心律失常的临床表现之间无显著相关性。
与Sx相比，ASx的特点是HR较低和HRV较高。在AS-Sx中，无症状期与有症状期相比，HR较低，HRV较高。这些发现提示自主神经系统活动的变化可能对心律失常的感知有影响。
