Makimoto Hisaki, Blockhaus Christian, Meyer Christian, Lin Tina, Jungen Christiane, Eickholt Christian, Clasen Lukas, Schmidt Jan, Kurt Muhammed, Müller Patrick, Shin Dong-In, Kelm Malte, Fürnkranz Alexander
Division of Cardiology, Respiratory and Vascular Medicine, University Duesseldorf, Medical Faculty, Moorenstr. 5, 40225 Duesseldorf, Germany.
Department of Cardiology and Electrophysiology, University Heart Center Hamburg, Hamburg, Germany.
Int J Cardiol Heart Vasc. 2018 Feb 26;18:33-38. doi: 10.1016/j.ijcha.2018.02.004. eCollection 2018 Mar.
The severity of symptoms during atrial fibrillation (AF) may be influenced by heart rate and blood pressure variation, due to irregular beats and the related adaptations in baroreflex sensitivity. This study investigated whether heart rate turbulence (HRT) as a reflection of baroreflex sensitivity is related to symptom severity during AF.
Ninety-seven patients (pts) who underwent electrophysiological study were enrolled. Consecutive 56 pts had paroxysmal AF (21 with milder symptoms [EHRA I or II; Group-M], 35 with severe symptoms [EHRA III or IV; Group-S]), and 41 age-matched controls without AF were included. After delivering a single ventricular extrastimulus during sinus rhythm and repeating the process 10 times, the quantification of HRT was performed by measuring turbulence onset (TO: heart rate acceleration) and turbulence slope (TS: rate of heart rate deceleration).
Group-M pts showed significantly diminished TO as compared to controls and Group-S pts (P = 0.012). There was no significant difference of the TS between the 3 groups. Given that a TO ≥ 0% or TS ≤ 2.5 ms/RR was considered abnormal, Group-M pts showed significantly higher incidences of abnormal HRT as compared to controls and Group-S pts (71% vs 40% vs 21%, respectively, P = 0.0012). Regression analysis demonstrated an independent and significant association between a diminished TO and milder AF symptoms (P < 0.05).
The usual heart rate acceleration after premature ventricular contraction is significantly diminished in pts with milder AF symptoms as compared to pts with severe AF symptoms. The mechanism of association between this diminished response and symptoms should be further investigated.
心房颤动（AF）期间症状的严重程度可能受心率和血压变化的影响，这是由于心律不齐以及压力反射敏感性的相关适应性变化所致。本研究调查了作为压力反射敏感性反映的心率震荡（HRT）是否与AF期间的症状严重程度相关。
纳入97例接受电生理研究的患者。连续56例阵发性AF患者（21例症状较轻[欧洲心律协会（EHRA）I或II级；M组]，35例症状严重[EHRA III或IV级；S组]），并纳入41例年龄匹配的无AF的对照者。在窦性心律期间发放单个室性期外刺激并重复该过程10次后，通过测量震荡起始（TO：心率加速）和震荡斜率（TS：心率减速速率）对HRT进行量化。
与对照组和S组患者相比，M组患者的TO显著降低（P = 0.012）。3组之间的TS无显著差异。鉴于TO≥0%或TS≤2.5 ms/RR被认为异常，与对照组和S组患者相比，M组患者异常HRT的发生率显著更高（分别为71%、40%和21%，P = 0.0012）。回归分析显示TO降低与较轻的AF症状之间存在独立且显著的关联（P < 0.05）。
与严重AF症状的患者相比，症状较轻的AF患者室性早搏后通常的心率加速显著降低。这种反应降低与症状之间关联的机制应进一步研究。
