Piha S J, Voipio-Pulkki L M
Social Insurance Institution, Rehabilitation Services, Turku, Finland.
Clin Auton Res. 1993 Jun;3(3):183-7. doi: 10.1007/BF01826231.
To assess the possible dysrhythmogenic effect of cardiovascular autonomic function tests, ECG tracings of 925 consecutive subjects, taken during a battery of cardiovascular autonomic reflex tests were analyzed. The battery included the Valsalva manoeuvre, deep breathing test, orthostatic and isometric handgrip. The frequency of ventricular extrasystoles increased during or after the tests, compared with the resting phase, in 11% of healthy subjects, in 11% of diabetic subjects and in 23% of subjects with a previous myocardial infarction (p = 0.001 vs healthy subjects). In patients with previous myocardial infarction, the most dysrhythmogenic individual tests were orthostatic and isometric handgrip. In nine subjects, other cardiac rhythm disturbances were detected (including nonsustained ventricular tachycardia, conduction block, and atrial fibrillation). In all cases, the dysrhythmias were asymptomatic and resolved without medical intervention. In conclusion, we consider the cardiovascular reflex test battery safe for the patient. However, due to occasional potentially significant dysrhythmias we recommend continuous monitoring of the electrocardiogram and immediate access to resuscitation facilities during cardiovascular autonomic testing.
为评估心血管自主功能测试可能产生的致心律失常作用，我们分析了连续925名受试者在一系列心血管自主反射测试过程中的心电图描记。该测试系列包括瓦尔萨尔瓦动作、深呼吸试验、直立位和等长握力试验。与静息期相比，在测试期间或测试后，11%的健康受试者、11%的糖尿病受试者以及23%的既往有心肌梗死的受试者室性期前收缩频率增加（与健康受试者相比，p = 0.001）。在既往有心肌梗死的患者中，致心律失常作用最强的单项测试是直立位和等长握力试验。在9名受试者中，检测到其他心律失常（包括非持续性室性心动过速、传导阻滞和心房颤动）。在所有病例中，心律失常均无症状，无需药物干预即可缓解。总之，我们认为该心血管反射测试系列对患者是安全的。然而，由于偶尔会出现潜在的严重心律失常，我们建议在心血管自主神经测试期间持续监测心电图，并确保能立即获得复苏设备。
