Schaller Claudine, Fümm Andrea, Bachmann Simon, Oechslin Luca, Nakahara Yoshi, Melliger Roger, Biaggi Patric, Wyss Christophe Alain
Heart Clinic Zürich, Switzerland.
IDUN Technologies AG, Glattpark (Opfikon), Switzerland.
Swiss Med Wkly. 2021 Oct 21;151:w30039. doi: 10.4414/smw.2021.w30039. eCollection 2021 Oct 11.
The aim of the present study was to describe heart rate profiles and heart rate variability patterns in non-selected scuba divers of different ages under non-experimental real-world conditions.
We used specially designed silver-loaded polydimethylsiloxane dry electrodes for underwater ECG recordings. With a custom-built setup, heart rate profiles and heart rate variability patterns were documented before submersion, during diving and after resurfacing in 18 separate dives.
Heart rates of the divers just before descent were remarkably high (median 114 bpm, interquartile range [IQR] 83-154) with a statistically significant rapid decrease after submersion (median 90 bpm, IQR 70-116; p = 0.008). The percentage heart rate reduction by submersion was individually very variable (median 21%, range 5-39%). We noted a general increase in autonomic nervous system (ANS) activity without predominance of parasympathetic parameters, suggesting a concomitant sympatheticadrenergic activation.
Scuba diving under real-world conditions by non-selected divers is characterised by relatively high heart rates just before submersion, an individually variable but significant bradycardic dive response, and induces an immediate and sustained parallel increase of parasympathetic and sympathetic-adrenergic autonomic nervous system activity. These observations could explain several specific pathophysiological mechanisms of diving incidents (haemodynamic decompensation, arrhythmias, acute coronary syndromes) and underlines the importance of cardiovascular risk stratification in diving eligibility assessment.
本研究的目的是描述在非实验性现实世界条件下不同年龄的未经过筛选的水肺潜水员的心率概况和心率变异性模式。
我们使用专门设计的镀银聚二甲基硅氧烷干电极进行水下心电图记录。通过定制装置，在18次单独潜水的潜水前、潜水期间和浮出水面后记录心率概况和心率变异性模式。
潜水员下降前的心率非常高（中位数114次/分钟，四分位间距[IQR]83 - 154），潜水后有统计学显著的快速下降（中位数90次/分钟，IQR 70 - 116；p = 0.008）。潜水导致的心率降低百分比个体差异很大（中位数21%，范围5 - 39%）。我们注意到自主神经系统（ANS）活动普遍增加，且副交感神经参数无优势，提示伴有交感 - 肾上腺素能激活。
未经过筛选的潜水员在现实世界条件下进行水肺潜水的特点是潜水前心率相对较高，潜水时心率有个体差异但显著减慢，并且会立即并持续平行增加副交感神经和交感 - 肾上腺素能自主神经系统活动。这些观察结果可以解释潜水事故的几种特定病理生理机制（血液动力学失代偿、心律失常、急性冠状动脉综合征），并强调了心血管风险分层在潜水资格评估中的重要性。
