Huang Jen-Hung, Lin Yung-Kuo, Hsieh Ming-Hsiung, Chen Shih-Ann, Chiu Wan-Chun, Chen Yi-Jen
Division of Cardiovascular Medicine, Department of Internal Medicine, Wan Fang Hospital, Taipei Medical University, Taipei, Taiwan.
Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.
Pacing Clin Electrophysiol. 2017 Apr;40(4):401-408. doi: 10.1111/pace.13045. Epub 2017 Mar 3.
Autonomic nervous activity plays a critical role in the genesis of paroxysmal atrial fibrillation (AF, PAF). However, the role of autonomic nervous activity on AF termination has not been elucidated. Heart rate variability (HRV) is widely used to evaluate autonomic nervous activity in humans. The purpose of this study was to assess whether autonomic nervous activity assessed by HRV contributes to AF termination.
Electrocardiograms (ECGs) and HRV were studied in patients with termination of sustained (>30 s) PAF by 24-hour ambulatory Holter monitoring. The 20-minute interval after termination of AF was divided into four segments of 5 minutes each, and a frequency analysis was applied to each 5-minute segment.
In 52 AF episodes, the ultra-low-frequency power, very-low-frequency power, low-frequency power (LF), high-frequency power (HF), and total power significantly decreased with time after episodes of AF termination. The LF/HF (L/H) ratio, normalized LF (LFnu), and normalized HF (HFnu) significantly changed after AF termination. Eighteen (35%) episodes had decreased LFnu and increased HFnu (sympathetic withdrawal and vagal activation), which had slower average AF ventricular responses (92 ± 16 beats/min vs 105 ± 24 beats/min, P < 0.05) than the AF termination episodes (n = 34, 65%) with increased LFnu and decreased HFnu (sympathetic activation and vagal withdrawal). Moreover, older patients (aged >65 years) had a higher incidence (n = 27, 75%) of AF termination with increased LFnu and decreased HFnu than did younger patients (aged ≤65 years, n = 7, 44%, P < 0.05).
Autonomic changes critically regulate termination of PAF, which is modulated by aging.
自主神经活动在阵发性心房颤动（房颤，PAF）的发生中起关键作用。然而，自主神经活动对房颤终止的作用尚未阐明。心率变异性（HRV）被广泛用于评估人体的自主神经活动。本研究的目的是评估通过HRV评估的自主神经活动是否有助于房颤的终止。
通过24小时动态心电图监测，对持续性（>30秒）PAF终止的患者进行心电图（ECG）和HRV研究。房颤终止后的20分钟间隔分为四个5分钟的时间段，对每个5分钟时间段进行频率分析。
在52次房颤发作中，超低频功率、极低频功率、低频功率（LF）、高频功率（HF）和总功率在房颤发作终止后随时间显著下降。LF/HF（L/H）比值、标准化LF（LFnu）和标准化HF（HFnu）在房颤终止后显著变化。18次（35%）发作的LFnu降低而HFnu升高（交感神经撤退和迷走神经激活），其平均房颤心室反应（92±16次/分钟对105±24次/分钟，P<0.05）比LFnu升高而HFnu降低（交感神经激活和迷走神经撤退）的房颤终止发作（n=34，65%）慢。此外，老年患者（年龄>65岁）房颤终止时LFnu升高而HFnu降低的发生率（n=27，75%）高于年轻患者（年龄≤65岁，n=7，44%，P<0.05）。
自主神经变化对PAF的终止起关键调节作用，且受年龄影响。
