Raeder E A, Hohnloser S H, Graboys T B, Podrid P J, Lampert S, Lown B
Department of Nutrition, Harvard University School, Boston, Massachusetts.
J Am Coll Cardiol. 1988 Sep;12(3):656-61. doi: 10.1016/s0735-1097(88)80052-4.
Day to day variability of ventricular ectopic activity was analyzed in 45 patients with a history of malignant ventricular tachyarrhythmias who underwent two successive 24 h periods of ambulatory electrocardiographic (ECG) monitoring in the absence of antiarrhythmic drugs; 26 were male and 19 female, with a mean age of 56 years (range 15 to 76). The total number of single ventricular premature beats, couplets and ventricular tachycardia beats and runs on days 1 and 2 demonstrated a consistent overall correlation (r = 0.76 to 0.84). Individual variability was evaluated by regression analysis with determination of 95% confidence limits. The minimal decrease in arrhythmia density necessary to distinguish true drug effect from spontaneous variability was 64% for single ventricular premature beats, 83% for couplets, 90% for ventricular tachycardia runs and 93% for ventricular tachycardia beats. To meet the criteria for arrhythmia aggravation, the arrhythmia density had to increase by 400, 877, 1,500 and 2,400%, respectively. Multivariate analysis disclosed an inverse relation between day to day arrhythmia variability and baseline arrhythmia density and age. Variability was more pronounced in patients with coronary artery disease but was not influenced by the type of presenting arrhythmia or left ventricular function. The diurnal distribution of arrhythmias and heart rate followed a distinct circadian pattern. These data indicate that, despite good group reproducibility, spontaneous arrhythmia variability in individuals is substantial, necessitating standards to define both drug effect and arrhythmia aggravation.
对45例有恶性室性心律失常病史的患者进行了室性异位活动的每日变异性分析，这些患者在未使用抗心律失常药物的情况下连续进行了两个24小时的动态心电图（ECG）监测；其中男性26例，女性19例，平均年龄56岁（范围15至76岁）。第1天和第2天单发性室性早搏、成对室性早搏以及室性心动过速的搏动和发作总数显示出一致的总体相关性（r = 0.76至0.84）。通过回归分析并确定95%置信区间来评估个体变异性。为了将真正的药物效应与自发变异性区分开来，单发性室性早搏的心律失常密度最小降幅需达到64%，成对室性早搏为83%，室性心动过速发作需达到90%，室性心动过速搏动需达到93%。要符合心律失常加重的标准，心律失常密度必须分别增加400%、877%、1500%和2400%。多变量分析显示，每日心律失常变异性与基线心律失常密度和年龄呈负相关。冠心病患者的变异性更为明显，但不受出现的心律失常类型或左心室功能的影响。心律失常和心率的昼夜分布遵循明显的昼夜节律模式。这些数据表明，尽管群体重复性良好，但个体的自发心律失常变异性很大，因此需要制定标准来界定药物效应和心律失常加重情况。
