Van Thanh Ngo, Hien Nguyen Sinh, Son Pham Nguyen, Son Pham Truong
Hanoi Heart Hospital, 92 Tran Hung Dao, Hoan Kiem District, Hanoi 11019, Vietnam.
108 Military Central Hospital, 1B Tran Hung Dao, Hai Ba Trung District, Hanoi 11600, Vietnam.
Cardiol Res Pract. 2022 Apr 30;2022:1455025. doi: 10.1155/2022/1455025. eCollection 2022.
Coronary artery bypass grafting (CABG) with extracorporeal circulation is a key therapy for coronary artery disease (CAD). However, cardiovascular events and cardiac arrhythmias may still occur in these patients following surgery. Many studies have demonstrated a correlation between cardiac arrhythmias and heart rate variability (HRV). This study aimed to establish the temporal change pattern of HRV observed following CABG.
A prospective method was used to study 119 consecutive patients with stable CAD who were assessed using 24-hour Holter recordings 2 days before CABG and 1 week, 3 months, and 6 months after the surgery at Hanoi Heart Hospital from June 2016 to August 2018. All the time-domain and frequency-domain parameters of HRV decreased precipitately after CABG and were mostly recovered 3 months postoperatively. The percentage of decreased HRV before surgery was 28.6% and 51.8% after 7 days, 19.6% after 3 months, and 12.7% after 6 months. ASDNN and SDNN before and after surgery had the highest rates of change.
The early decrease in HRV observed 7 days after CABG may be related to the acute effects of the surgery. The recovery of HRV at 3 months after surgery, regardless of the preoperative state of the patients, implies that the autonomic nervous system (ANS) disorder may be improved at this time. At 6 months after surgery, the autonomic nervous injury was recovered in combination with improvement of reperfusion, resulting in improvement in almost all HRV indices compared with those indices preoperatively.
体外循环冠状动脉旁路移植术（CABG）是治疗冠状动脉疾病（CAD）的关键疗法。然而，这些患者术后仍可能发生心血管事件和心律失常。许多研究已证明心律失常与心率变异性（HRV）之间存在关联。本研究旨在确定CABG术后HRV的时间变化模式。
采用前瞻性方法，对2016年6月至2018年8月在河内心脏医院连续收治的119例稳定型CAD患者进行研究，在CABG术前2天以及术后1周、3个月和6个月使用24小时动态心电图记录进行评估。CABG术后HRV的所有时域和频域参数均急剧下降，术后3个月大多恢复。术前HRV下降的百分比在术后7天为28.6%，术后7天为51.8%，术后3个月为19.6%，术后6个月为12.7%。手术前后ASDNN和SDNN的变化率最高。
CABG术后7天观察到的HRV早期下降可能与手术的急性效应有关。术后3个月HRV的恢复，无论患者术前状态如何，都意味着此时自主神经系统（ANS）紊乱可能得到改善。术后6个月，自主神经损伤随着再灌注的改善而恢复，与术前相比，几乎所有HRV指标均有所改善。
