Cinca J, Moya A, Figueras J, Roma F, Rius J
Am Heart J. 1986 Aug;112(2):315-21. doi: 10.1016/0002-8703(86)90268-1.
To assess the variability of the currently used electrophysiologic parameters and their possible circadian rhythm, sequential bedside electrophysiologic testing was performed during a 24-hour period, at intervals of 1 to 2 hours, in 12 patients who had normal atrioventricular (AV) conduction times and normal sinus node function. The coefficients of variation during the 24-hour period were: +/- 10.4% for the R-R interval, +/- 10.6% for the sinus node recovery time (SRT) at atrial pacing of 100 bpm, +/- 32.5% for the corrected SRT, +/- 15.1% for the ventriculoatrial (VA) effective refractory period (ERP), +/- 8.3% for the AV nodal ERP, +/- 5.7% for the AH interval, +/- 5.2% for the HV interval, +/- 5.5% for the atrial ERP, +/- 3.3% for the right ventricular ERP, +/- 2.8% for the QT interval, +/- 4% for the VA interval, and +/- 3.4% for the retrograde Kent bundle ERP. Between 12:00 midnight and 7:00 AM, there was significant lengthening of: the sinus node rate (p less than 0.0005), the SRT at atrial paced rates of 100 and 120 bpm (p less than 0.025), the QT interval duration (p less than 0.025), and the ERP of the atria (p less than 0.025), AV node (p less than 0.01), and right ventricle (p less than 0.05). Thus conventional electrophysiologic parameters are subject to daily variability and, like sinus node function, AV nodal and myocardial refractoriness follow a circadian rhythm with an acrophase between 12:00 midnight and 7:00 AM. In addition, prolonged bedside recording of the His bundle potential can be reliably obtained.
为评估当前使用的电生理参数的变异性及其可能的昼夜节律，对12名房室（AV）传导时间正常且窦房结功能正常的患者在24小时内每隔1至2小时进行一次连续床边电生理测试。24小时期间的变异系数分别为：R-R间期为±10.4%，心房起搏频率为100次/分时的窦房结恢复时间（SRT）为±10.6%，校正后的SRT为±32.5%，室房（VA）有效不应期（ERP）为±15.1%，房室结ERP为±8.3%，AH间期为±5.7%，HV间期为±5.2%，心房ERP为±5.5%，右心室ERP为±3.3%，QT间期为±2.8%，VA间期为±4%，逆向Kent束ERP为±3.4%。在午夜12点至上午7点之间出现显著延长的有：窦房结频率（p<0.0005）、心房起搏频率为100和120次/分时的SRT（p<0.025）、QT间期持续时间（p<0.025）以及心房（p<0.025）、房室结（p<0.01）和右心室（p<0.05）的ERP。因此，传统电生理参数存在每日变异性，并且与窦房结功能一样，房室结和心肌不应期遵循昼夜节律，其高峰相位在午夜12点至上午7点之间。此外，可可靠地获得His束电位的长时间床边记录。
