通过心率变异性评估心房颤动发作前的自主神经系统活动。

Autonomic Nervous System Activity before Atrial Fibrillation Onset as Assessed by Heart Rate Variability.

作者信息

Grégoire Jean-Marie, Gilon Cédric, Marelli François, Godart Pascal, Bersini Hugues, Carlier Stéphane

机构信息

IRIDIA, Université Libre de Bruxelles, 1050 Bruxelles, Belgium.

Cardiology Department, Université de Mons, 7000 Mons, Belgium.

出版信息

Rev Cardiovasc Med. 2025 Jan 8;26(1):25364. doi: 10.31083/RCM25364. eCollection 2025 Jan.

DOI:10.31083/RCM25364

PMID:39867192

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11760543/

Abstract

BACKGROUND

Neuromodulation has been shown to increase the efficacy of atrial fibrillation (AF) ablation procedures. However, despite its ability to influence the autonomic nervous system (ANS), the exact mechanism of action remains unclear. The activity of the ANS via the intracardiac nervous system (ICNS) can be inferred from heart rate variability (HRV). Therefore, this study aims to investigate the significance of changes in the ICNS prior to the onset of AF by analyzing the evolution of HRV in a large new cohort of patients.

METHODS

We selected and annotated recordings with AF and atrial flutter from our database of 95,871 Holter recordings. Each recording included both sinus rhythm and one or more AF episodes. We computed parameters estimating parasympathetic activity (root mean square of successive RR interval differences (RMSSD) and percentage of successive RR intervals that differ by more than 50 ms (pNN50)), as well as HRV frequential parameters a few minutes before AF onset. To allow a minute-by-minute assessment of the parameter changes, we computed their values over 5-minute sliding windows, starting at 35 minutes before AF onset.

RESULTS

The mean age of the whole group of patients was 71.1 ± 11.3 years (range 35-99), the total number of episodes was 1319 on 623 recordings from 570 patients, with an average of 2.1 ± 2.2 episodes per recording (range 1-17) and 2.3 ± 2.6 episodes per patient (range 1-21). The proportion of premature atrial contractions (PACs) increased from 4.8 ± 0.3%, 35 minutes before the onset of AF to 8.3 ± 0.4%, 5 minutes before the AF episode. We measured a statistically significant increase in very-low-frequency (VLF), low-frequency (LF), high-frequency (HF), RMSSD and pNN50 between 35 minutes and 5 minutes before AF onset.

CONCLUSIONS

Our data suggest that a significant short-term increase in vagal activity precedes most AF events. Dynamic changes in HRV parameters could be considered when determining the optimal neuromodulation strategies.

摘要

背景

神经调节已被证明可提高心房颤动（AF）消融手术的疗效。然而，尽管其能够影响自主神经系统（ANS），但其确切作用机制仍不清楚。通过心脏内神经系统（ICNS）的ANS活动可从心率变异性（HRV）推断出来。因此，本研究旨在通过分析一大群新患者的HRV演变情况，探讨AF发作前ICNS变化的意义。

方法

我们从95871份动态心电图记录数据库中选择并标注了AF和心房扑动的记录。每份记录都包括窦性心律和一个或多个AF发作。我们计算了估计副交感神经活动的参数（连续RR间期差值的均方根（RMSSD）和连续RR间期相差超过50毫秒的百分比（pNN50）），以及AF发作前几分钟的HRV频率参数。为了逐分钟评估参数变化，我们从AF发作前35分钟开始，在5分钟滑动窗口内计算它们的值。

结果

整个患者组的平均年龄为71.1±11.3岁（范围35 - 99岁），发作总数为1319次，来自570例患者的623份记录，每份记录平均2.1±2.2次发作（范围1 - 17次），每位患者平均2.3±2.6次发作（范围1 - 21次）。房性早搏（PACs）的比例从AF发作前35分钟的4.8±0.3%增加到AF发作前5分钟的8.3±0.4%。我们测量到AF发作前35分钟至5分钟期间，极低频（VLF）、低频（LF）、高频（HF）、RMSSD和pNN50有统计学意义的增加。