Manolis Antonis A, Manolis Theodora A, Manolis Antonis S
Elpis General Hospital of Athens, Athens, Greece.
Aiginiteio University Hospital, Athens, Greece.
Heart Rhythm. 2024 Oct 11. doi: 10.1016/j.hrthm.2024.10.013.
Circadian rhythms follow 24-hour biological cycle patterns controlled by internal biological or circadian clocks that optimize organismal homeostasis according to predictable environmental changes. These clocks are found in virtually all cells in the body, including cardiomyocytes. Triggers for and/or the occurrence of sudden cardiac death (SCD) and cardiac arrhythmias seem to follow such daily patterns. This review highlights data from studies exploring the role of day/night rhythms in the timing of arrhythmic events, studies describing the environmental, behavioral, and circadian mechanisms regulating cardiac electrophysiology focusing on the circadian pattern of arrhythmias and SCD. Mechanisms involved relate to circadian control of electrophysiological properties, vagal tone, and sleep disorders, as well as the potential interaction and synergism among these factors. By studying the diurnal variations of arrhythmias, therapy can be improved by optimally timing it to their circadian pattern and a person's internal body clock time. Potential treatment targets for arrhythmias with nocturnal onset may include upstream therapy for underlying comorbidities, type and timing of drug intake, pulmonary vein isolation, ablation of the ganglionated plexus, and autonomic nervous system control. Thus, specific history-taking, screening, and diagnostic workup are recommended to identify and characterize comorbidities and potential contributors to nocturnal arrhythmias, such as obesity, advanced age, diabetes, hypertension, and heart failure. In this direction, symptoms of sleep apnea may comprise snoring and excessive daytime sleepiness. Risk factors include obesity, decreased upper airway dimensions, and heart failure. Thus, one should have a low threshold for sleep testing to assess for sleep apnea. Sleep apnea treatment decreases ventricular arrhythmias and ameliorates some severe bradycardic episodes, often obviating the need for pacemaker implantation. Importantly, comorbidity treatment and lifestyle optimization remain crucial.
昼夜节律遵循由内部生物钟控制的24小时生物周期模式，这些生物钟根据可预测的环境变化优化机体的内稳态。这些生物钟几乎存在于人体的所有细胞中，包括心肌细胞。心脏性猝死（SCD）和心律失常的触发因素及/或发生似乎遵循这种每日模式。本综述重点介绍了探索昼夜节律在心律失常事件发生时间方面作用的研究数据，以及描述调节心脏电生理学的环境、行为和昼夜机制的研究，重点关注心律失常和SCD的昼夜模式。涉及的机制与电生理特性的昼夜控制、迷走神经张力和睡眠障碍有关，以及这些因素之间的潜在相互作用和协同作用。通过研究心律失常的昼夜变化，可以根据其昼夜模式和个体的内部生物钟时间优化治疗时机，从而改善治疗效果。夜间发作的心律失常的潜在治疗靶点可能包括针对潜在合并症的上游治疗、药物摄入的类型和时间、肺静脉隔离、神经节丛消融以及自主神经系统控制。因此，建议进行特定的病史采集、筛查和诊断检查，以识别和表征合并症以及夜间心律失常的潜在促成因素，如肥胖、高龄、糖尿病、高血压和心力衰竭。在这方面，睡眠呼吸暂停的症状可能包括打鼾和白天过度嗜睡。危险因素包括肥胖、上气道尺寸减小和心力衰竭。因此，对于睡眠测试以评估睡眠呼吸暂停应保持较低的阈值。睡眠呼吸暂停治疗可减少室性心律失常并改善一些严重的心动过缓发作，通常无需植入起搏器治疗。重要的是，合并症治疗和生活方式优化仍然至关重要。
