Wessel Niels, Berg Karsten, Kraemer Jan F, Gapelyuk Andrej, Rietsch Katrin, Hauser Tino, Kurths Jürgen, Wenzel Dave, Klein Norbert, Kolb Christof, Belke Roberto, Schirdewan Alexander, Kääb Stefan
Department of Physics, Humboldt-Universität zu Berlin, Berlin, Germany.
BIOTRONIK, Berlin, Germany.
Front Physiol. 2020 Dec 8;11:596844. doi: 10.3389/fphys.2020.596844. eCollection 2020.
The REACT DX registry evaluates standard therapies to episodes of long-lasting atrial tachyarrhythmias and assesses the quality of sensing and stability of the lead and the implantable cardioverter-defibrillator (ICD) (BIOTRONIK Lumax VR-T DX and successors) over at least a 1-year follow-up period.
To study the association between the risk of device-detected atrial fibrillation (AF), the autonomic perturbations before the onset of paroxysmal AF and a 7-days heart rate variability (7dHRV) 1 month after ICD implantation.
The registry consists of 234 patients implanted with an ICD, including 10 with long-lasting atrial tachyarrhythmias with no prior history of AF. The patients were matched via the propensity-score methodology as well as for properties directly influencing the ECGs recorded using GE CardioMem CM 3000. Heart rate variability (HRV) analysis was performed using standard parameters from time- and frequency-domains, and from non-linear dynamics.
No linear HRV was associated with an increased risk of AF ( = n.s.). The only significant approach was derived from symbolic dynamics with the parameter "forbidden words" which distinguished both groups on all 7 days of measurements ( < 0.05), thereby quantifying the heart rate complexity (HRC) as drastically lower in the AF group.
Cardiac autonomic dysfunction denoted by low HRC may be associated with higher AF incidence. For patients with mild to moderate heart failure, standard HRV parameters are not appropriate to quantify cardiac autonomic perturbations before the onset of AF. Further studies are needed to determine the individual risk for AF that would enable interventions to restore autonomic balance in the general population.
REACT DX注册研究评估了针对持续性房性快速心律失常发作的标准疗法，并在至少1年的随访期内评估了感知质量、导线及植入式心脏复律除颤器（ICD）（百多力Lumax VR-T DX及其后续型号）的稳定性。
研究设备检测到的心房颤动（AF）风险、阵发性AF发作前的自主神经紊乱与ICD植入后1个月的7天心率变异性（7dHRV）之间的关联。
该注册研究纳入了234例植入ICD的患者，其中10例为无AF病史的持续性房性快速心律失常患者。通过倾向评分法以及直接影响使用GE CardioMem CM 3000记录的心电图的特性对患者进行匹配。使用时域、频域和非线性动力学的标准参数进行心率变异性（HRV）分析。
线性HRV与AF风险增加无关（P = 无统计学意义）。唯一显著的方法来自符号动力学中的“禁词”参数，该参数在所有7天的测量中区分了两组（P < 0.05），从而将AF组的心率复杂性（HRC）量化为显著更低。
低HRC表示的心脏自主神经功能障碍可能与较高的AF发生率相关。对于轻至中度心力衰竭患者，标准HRV参数不适用于量化AF发作前的心脏自主神经紊乱。需要进一步研究以确定AF的个体风险，从而使能够在普通人群中恢复自主神经平衡的干预措施成为可能。
