Jhuo Shih-Jie, Lo Li-Wei, Chang Shih-Lin, Lin Yenn-Jiang, Chung Fa-Po, Hu Yu-Feng, Chao Tze-Fan, Tuan Ta-Chuan, Liao Jo-Nan, Lin Chin-Yu, Chang Yao-Ting, Lin Chung-Hsing, Walia Rohit, Te Abigail Louise D, Yamada Shinya, Raharjo Sunu Budhi, Tang Wei-Hua, Lee Kun-Tai, Lai Wen-Ter, Chen Shih-Ann
Division of Cardiology, Kaohsiung Medical University Hospital Division of Cardiology, Taipei Veterans General Hospital Institute of Clinical Medicine, and Cardiovascular Research Center, Faculty of Medicine, College of Medicine, National Yang-Ming Medical University, Taipei Department of Internal Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.
Medicine (Baltimore). 2017 Apr;96(15):e6516. doi: 10.1097/MD.0000000000006516.
Diurnal variations in ventricular tachyarrhythmias (VAs) have been demonstrated in idiopathic arrhythmogenic heart disease. The electrophysiological characteristics of diurnal variations in idiopathic right ventricular outflow tract (RVOT) VA have not previously been elucidated. Sixty-two consecutive patients undergoing catheter ablation for idiopathic RVOT VA (mean age: 42.8 ± 12.3 years, 35 females) were enrolled. The diurnal variation type (group 1, n = 36) was defined as those patients who had most ventricular premature contractions (VPCs) during the night hours by preprocedure Holter recordings. Group 2 (n = 26) was defined as those patients who did not have significant VPC variations. The baseline characteristics and electrophysiological properties were collected and analyzed, and the rates of recurrence after catheter ablation were compared between the 2 groups. In this study, heart rate variability analysis demonstrated lower low frequency/high frequency ratios in group 1 than in group 2 (3.95 ± 3.08 vs 6.26 ± 5.33; P = 0.042). There were no significant differences in baseline characteristics, echocardiography and electrophysiological characteristics between the 2 groups. During a mean follow-up period of 13.5 ± 11.0 months, a total of 16 patients had VA recurrences, including 13 patients from group 1 and 3 patients from group 2 (36.1% vs 12.5%, P = 0.039). This study demonstrated the effect of the autonomic nervous system in idiopathic RVOT VAs and that the diurnal variation type leads to a higher recurrence rate after catheter ablation.
室性快速心律失常（VA）的昼夜变化已在特发性致心律失常性心脏病中得到证实。特发性右心室流出道（RVOT）VA昼夜变化的电生理特征此前尚未阐明。连续纳入62例接受特发性RVOT VA导管消融术的患者（平均年龄：42.8±12.3岁，女性35例）。昼夜变化类型（第1组，n = 36）定义为术前动态心电图记录显示夜间室性早搏（VPC）最多的患者。第2组（n = 26）定义为VPC无显著变化的患者。收集并分析两组患者的基线特征和电生理特性，并比较两组导管消融术后的复发率。在本研究中，心率变异性分析显示第1组的低频/高频比值低于第2组（3.95±3.08 vs 6.26±5.33；P = 0.042）。两组患者的基线特征、超声心动图和电生理特征无显著差异。在平均13.5±11.0个月的随访期内，共有16例患者出现VA复发，其中第1组13例，第2组3例（36.1% vs 12.5%，P = 0.039）。本研究证明了自主神经系统在特发性RVOT VA中的作用，以及昼夜变化类型导致导管消融术后更高的复发率。
