Hohnloser S H, van de Loo A, Klingenheben T
Medizinische Universitätsklinik III, Kardiologie, Freiburg.
Z Kardiol. 1994;83 Suppl 5:21-7.
The autonomic nervous system plays an important role in the genesis of various cardiac rhythm disorders. Experimental studies have indicated that in atrial fibrillation particularly vagal activity may have a decisive influence on the electrophysiologic properties of atrial myocardium. In patients with paroxysmal atrial fibrillation, a carefully taken history and electrocardiographic findings obtained during Holter monitoring can help to distinguish vagally mediated from adrenergically mediated atrial fibrillation. The former is considered to represent a form of lone atrial fibrillation affecting particularly males aged 40 to 50 years. The arrhythmic episodes manifest themselves most often during the night lasting from minutes to hours. There is a lack of tendency towards the development of permanent atrial fibrillation. Digitalis glycosides or beta-receptor antagonists are not helpful in the therapy of this form of atrial fibrillation whereas class I antiarrhythmic drugs have been shown to be more effective. Adrenergically mediated atrial fibrillation is in general less frequently observed than the vagally-induced form. In patients with episodes of atrial fibrillation provoked by emotional or physical stress, the diagnosis of adrenergically mediated atrial fibrillation should be suspected. The episodes of atrial fibrillation occur mostly during daytime. beta-receptor antagonists play a major role in the treatment of this form of atrial fibrillation.
自主神经系统在各种心律失常的发生中起重要作用。实验研究表明，特别是在心房颤动中，迷走神经活动可能对心房心肌的电生理特性具有决定性影响。对于阵发性心房颤动患者，详细的病史采集以及动态心电图监测期间获得的心电图结果有助于区分迷走神经介导的心房颤动和肾上腺素能介导的心房颤动。前者被认为是孤立性心房颤动的一种形式，尤其多见于40至50岁的男性。心律失常发作最常发生在夜间，持续数分钟至数小时。发展为永久性心房颤动的倾向较小。洋地黄糖苷或β受体拮抗剂对这种形式的心房颤动治疗无效，而I类抗心律失常药物已被证明更有效。一般来说，肾上腺素能介导的心房颤动比迷走神经诱发的形式少见。对于因情绪或身体应激诱发心房颤动发作的患者，应怀疑肾上腺素能介导的心房颤动的诊断。心房颤动发作大多发生在白天。β受体拮抗剂在这种形式的心房颤动治疗中起主要作用。
