Kim San Ha, Lim Kyoung Ree, Seo Jeong-Hun, Ryu Dong Ryeol, Lee Bong-Ki, Cho Byung-Ryul, Chun Kwang Jin
Division of Cardiology, Department of Internal Medicine, Kangwon National University Hospital, Kangwon National University School of Medicine, 156, Baekryung-ro, Chuncheon, Gangwon-do, 24289, South Korea.
Department of Internal Medicine, Kyung Hee University Hospital at Gangdong, Seoul, South Korea.
Sci Rep. 2022 Mar 8;12(1):3702. doi: 10.1038/s41598-022-07783-3.
The autonomic nervous system (ANS) plays an important role in the initiation and maintenance of atrial fibrillation (AF). However, the meaning of higher heart rate variability (HRV) in predicting AF remains unclear. Among 2100 patients in the Holter registry, a total of 782 hypertensive patients were included in this study. Baseline HRV was measured by time domain and frequency domain methods using 24-h Holter monitoring. The primary outcome was the development of AF. During an average follow-up of 1.1 years, 44 patients developed AF. Higher HRV parameters including high-frequency (P < 0.001), the square root of the mean squared differences of successive NN intervals (P < 0.001), and the percentage of NN intervals that are more than 50 ms different from the previous interval (P < 0.001) were associated with the occurrence of AF in univariate analysis. Premature atrial contractions burden, lower baseline heart rate, age, hemodialysis, coronary artery disease, and chronic heart failure were also associated with AF. In Cox regression analysis, higher HRV (representing excessive autonomic fluctuation) was an independent risk factor for AF. Excessive autonomic fluctuation represented by higher HRV in patients with hypertension was associated with an increased risk of AF.
自主神经系统（ANS）在心房颤动（AF）的发生和维持中起着重要作用。然而，较高的心率变异性（HRV）在预测AF方面的意义仍不明确。在动态心电图登记的2100例患者中，本研究共纳入782例高血压患者。使用24小时动态心电图监测，通过时域和频域方法测量基线HRV。主要结局是AF的发生。在平均1.1年的随访期间，44例患者发生了AF。在单因素分析中，较高的HRV参数包括高频（P＜0.001）、连续NN间期均方差的平方根（P＜0.001）以及与前一间期相差超过50毫秒的NN间期百分比（P＜0.001）与AF的发生相关。房性早搏负担、较低的基线心率、年龄、血液透析、冠状动脉疾病和慢性心力衰竭也与AF相关。在Cox回归分析中，较高的HRV（代表自主神经波动过度）是AF的独立危险因素。高血压患者中以较高HRV为代表的自主神经波动过度与AF风险增加相关。
