Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, PR China; Cardiovascular Research Institute, Wuhan University, Wuhan 430060, PR China; Hubei Key Laboratory of Cardiology, Wuhan 430060, PR China.
Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan 430060, PR China; Cardiovascular Research Institute, Wuhan University, Wuhan 430060, PR China; Hubei Key Laboratory of Cardiology, Wuhan 430060, PR China.
Heart Lung Circ. 2020 Aug;29(8):1152-1163. doi: 10.1016/j.hlc.2019.11.009. Epub 2019 Dec 3.
Patients with premature ventricular complexes (PVCs) usually experience accompanying alterations of the autonomic nerve system. The timing of PVC occurrence is associated with different circadian rhythms, which may be related to the autonomic nerve imbalance. The relationship between night-time PVC and cardiac autonomic nervous activity is still obscure. Our study aimed to investigate the relationship between the number of night-time PVCs and cardiac autonomic nervous activity.
We enrolled 72 patients with frequent PVCs and 27 without PVCs. The patients with PVCs were divided into two groups based on the number of night-time PVCs (i.e., PVCs occurring between 10 pm and 6 am/24-hr total PVCs; group 1: n=34, <30%; group 2: n=38, >30%). At baseline, 12-lead electrocardiogram and 24-hour Holter recording were performed. When the number of PVCs declined significantly after radiofrequency catheter ablation, Holter monitoring was performed again. Heart rate (HR) variability, mean 24-hour HR, mean daytime HR, and mean night-time HR were analysed.
With a greater number of night-time PVCs, group 2 had a lower standard deviation of all NN intervals (SDNN; 116.5±38.3 vs 135.3±37.8 ms; p=0.035) and increased mean 24-hour HR (77.3±9.2 vs 73.4±7.5 beats per min; p=0.05) than group 1. The SDNN was negatively correlated with the number of night-time PVCs and mean night-time HR (r= -3.04 and r= -0.504, respectively; p=0.009 and p=<0.001, respectively), and night-time PVC proportion was positively correlated with the ratio of low-frequency power (LF)/high-frequency power (HF; r=0.319 [p=0.013]). Multivariate linear regression analysis showed that the number of night-time PVCs was an independent predictor of decreased SDNN (β= -0.446, p=0.030) and increased LF/HF ratio (β=0.027, p=0.038). After PVCs disappeared, SDNN increased significantly and the frequency domain of the square root of the mean of the sum of the squares of differences between adjacent NN intervals, NN50 count divided by the total number of all NN intervals, the time domain of natural logarithm of HF, natural logarithm of LF, and mean 24-hour HR were significantly decreased in the two PVC groups.
An increased number of night-time PVCs was accompanied by enhanced cardiac sympathetic activity. After PVCs diminished, both cardiac parasympathetic and sympathetic nervous activity declined.
频发室性早搏（PVCs）患者通常伴有自主神经系统的改变。PVC 的发生时间与不同的昼夜节律有关，这可能与自主神经失衡有关。夜间 PVC 与心脏自主神经活动之间的关系仍不清楚。我们的研究旨在探讨夜间 PVC 次数与心脏自主神经活动之间的关系。
我们纳入了 72 例频发 PVC 患者和 27 例无 PVC 患者。根据夜间 PVC 数（即 10 点至 6 点/24 小时总 PVC 数；组 1：n=34，<30%；组 2：n=38，>30%）将 PVC 患者分为两组。在基线时，进行 12 导联心电图和 24 小时动态心电图监测。在射频导管消融后 PVC 数量显著减少时，再次进行动态心电图监测。分析心率（HR）变异性、24 小时平均 HR、白天平均 HR 和夜间平均 HR。
与夜间 PVC 较多的组 2 相比，组 2 的所有 NN 间期标准差（SDNN；116.5±38.3 与 135.3±37.8 ms；p=0.035）和 24 小时平均 HR（77.3±9.2 与 73.4±7.5 次/分；p=0.05）较低。SDNN 与夜间 PVC 次数和夜间平均 HR 呈负相关（r=-3.04 和 r=-0.504，p=0.009 和 p<0.001），夜间 PVC 比例与低频功率（LF）/高频功率（HF）比值呈正相关（r=0.319 [p=0.013]）。多元线性回归分析显示，夜间 PVC 次数是 SDNN 降低（β=-0.446，p=0.030）和 LF/HF 比值升高（β=0.027，p=0.038）的独立预测因子。在 PVC 消失后，两组的 SDNN 均显著增加，频域平方根均方根的 NN50 计数除以所有 NN 间期的总数、时域高频的自然对数、自然对数的 LF 和 24 小时平均 HR 均显著降低。
夜间 PVC 次数增加伴发心脏交感神经活动增强。在 PVC 减少后，心脏副交感和交感神经活动均下降。
