Paolillo V, Marra S, Chiappa E, Boncompagni F, Oddenino G, Spadaccini F, Angelino P F
G Ital Cardiol. 1981;11(1):12-22.
87 24-hour electrocardiographic monitoring sessions were conducted in 71 ambulatory patients (pts) in the early post-hospital phase after acute myocardial infarction. 29 (41%) had anterior, 42 (59%) inferoposterior myocardial infarction, 44 (62%) had angina or asymptomatic ischemia, 7 (10%) were in cardiac failure (II-III class NYHA). The occurrence of ventricular ectopic activity (VEA) during sleep hours was compared to the awake state; VEA during sexual and other activities of the awake state was studied. Excluding pts free of VEA during 24-hour monitoring the number of ventricular mature beats was lowered in 71% of sessions and augmented in 12% during sleep hours (p less than 0.001). Maximal grade of VEA was observed during wakefulness in 62% of session and in 9% during sleep (p less than 0.001); in 9% there was no difference, in 20% no VEA occurred. Total VEA, bi-tri-quadrigeminism and repetitive extrasystoles were significantly reduced during sleep: p less than 0.001, p less than 0.05 and p less than 0.01 respectively. This pattern was independent from site of infarction, presence of ischemia, cardiac failure (II-III class NYHA). A discrete correlation was observed between total VEA and heart rate; a poor correlation was seen between total VEA, multiform and repetitive extrasystoles. During wakefulness VEA was mainly related to physical exertion and emotional stress. Sleep and relax periods of the day showed VEA similar to sleeping hours of the night. Sexual activity did not significantly elicit more VEA than other activities of the awake state. Repetitive forms, observed in 8% of the population, were probably related to the rapid increase of sympathetic tone. The absence of repetitive VEA, potentially dangerous, during sleep hours (except the first) not due to antiarrhythmic drugs suggests to increase the dosage of these medications during the awake state in the majority of these pts.
对71例急性心肌梗死后出院早期的门诊患者进行了87次24小时动态心电图监测。其中29例（41%）为前壁心肌梗死，42例（59%）为下后壁心肌梗死，44例（62%）有心绞痛或无症状性心肌缺血，7例（10%）为心力衰竭（纽约心脏协会II - III级）。比较了睡眠期间与清醒状态下室性异位活动（VEA）的发生情况；研究了清醒状态下性活动及其他活动期间的VEA。排除24小时监测期间无VEA的患者，71%的监测时段睡眠期间室性成熟搏动数量减少，12%增加（p<0.001）。62%的监测时段在清醒时观察到VEA的最大分级，9%在睡眠时观察到（p<0.001）；9%无差异，20%未出现VEA。睡眠期间总VEA、二联律、三联律和四联律及重复性早搏明显减少：分别为p<0.001、p<0.05和p<0.01。这种模式与梗死部位、缺血情况、心力衰竭（纽约心脏协会II - III级）无关。总VEA与心率之间存在离散相关性；总VEA、多形性和重复性早搏之间相关性较差。清醒时VEA主要与体力活动和情绪应激有关。白天的睡眠和放松时段的VEA与夜间睡眠时段相似。性活动引发的VEA并不比清醒状态下的其他活动明显更多。在8%的人群中观察到的重复性形式可能与交感神经张力的快速增加有关。睡眠期间（除首次外）未因抗心律失常药物而出现潜在危险的重复性VEA，提示在大多数此类患者的清醒状态下增加这些药物的剂量。
