Wood M A, Simpson P M, London W B, Stambler B S, Herre J M, Bernstein R C, Ellenbogen K A
Department of Medicine, Medical College of Virginia, Richmond 23298.
J Am Coll Cardiol. 1995 Mar 15;25(4):901-7. doi: 10.1016/0735-1097(94)00460-8.
This study examined the temporal patterns of ventricular tachycardia detections by implantable cardioverter-defibrillators for circadian variability.
Previous studies of circadian arrhythmia patterns have been methodologically limited by very brief observational periods. Late-generation implantable cardioverter-defibrillators accurately record the times of arrhythmia detections during unlimited follow-up.
Forty-three patients with late-generation implantable cardioverter-defibrillators were followed up for 226 +/- 179 days (mean +/- SD). The times of all recorded episodes of ventricular tachyarrhythmias were retrieved from the data log of each device during follow-up.
The weighted distribution of 830 ventricular tachyarrhythmia episodes from the 43 patients fit a single harmonic sine curve model with a peak between 2 and 3 P.M. (95% confidence interval 1:13 to 4:13 P.M., R = 0.75, p < 0.05). The distributions of spontaneously terminating episodes, episodes receiving device therapy, episodes receiving shocks and episodes in the absence of antiarrhythmic therapy also fit the sine curve model (all R = 0.53 and 0.73, all p < 0.05), all with peak frequencies between 2:08 and 3:09 P.M. and 95% confidence intervals for peak frequencies between 11:38 A.M. and 5:07 P.M. Episodes recorded during continuous antiarrhythmic drug therapy did not fit the model (p > 0.05).
The distribution of ventricular tachyarrhythmias detected by late-generation implantable cardioverter-defibrillators follows a circadian pattern, with a peak tachycardia frequency between noon and 5 P.M. This pattern was not observed in patients receiving antiarrhythmic drug therapy. Knowledge of circadian periodicity for these events has implications for patient management.
本研究通过植入式心脏复律除颤器检测室性心动过速的时间模式，以探讨昼夜节律变异性。
既往关于昼夜节律性心律失常模式的研究在方法上受到观察期过短的限制。新一代植入式心脏复律除颤器可在无限制的随访期间准确记录心律失常检测时间。
对43例植入新一代植入式心脏复律除颤器的患者进行了226±179天（平均±标准差）的随访。在随访期间，从每个设备的数据记录中检索所有记录的室性快速心律失常发作时间。
43例患者的830次室性快速心律失常发作的加权分布符合单一谐波正弦曲线模型，峰值出现在下午2点至3点之间（95%置信区间为下午1点13分至4点13分，R = 0.75，p < 0.05）。自发终止发作、接受设备治疗的发作、接受电击的发作以及未接受抗心律失常治疗的发作的分布也符合正弦曲线模型（所有R = 0.53和0.73，所有p < 0.05），所有峰值频率均在下午2点08分至3点09分之间，峰值频率的95%置信区间在上午11点38分至下午5点07分之间。在持续抗心律失常药物治疗期间记录的发作不符合该模型（p > 0.05）。
新一代植入式心脏复律除颤器检测到的室性快速心律失常的分布遵循昼夜节律模式，心动过速频率峰值在中午至下午5点之间。在接受抗心律失常药物治疗的患者中未观察到这种模式。了解这些事件的昼夜周期性对患者管理具有重要意义。
