Lampert R, Rosenfeld L, Batsford W, Lee F, McPherson C
Yale University School of Medicine, Yale-New Haven Hospital, Conn. 06511.
Circulation. 1994 Jul;90(1):241-7. doi: 10.1161/01.cir.90.1.241.
While previous studies using epidemiological data and ambulatory ECG monitoring have shown peak occurrence of sudden death and nonsustained ventricular tachycardia in the morning, none have examined circadian variation of potentially life-threatening ventricular tachycardia (VT), nor has any study observed circadian behavior of any arrhythmias in individuals followed longitudinally. We used the event memory of multiprogrammable implantable cardioverter-defibrillators to evaluate the circadian pattern of sustained VT over time.
Data were reviewed from 32 consecutive patients with coronary artery disease and sustained VT who had received the Ventak PRX (CPI, Inc) cardioverter-defibrillator between May 1991 and August 1993 and had experienced at least one episode of VT terminated by their device. Mean follow-up was 14 +/- 7 months. Among the 2558 episodes recorded by the device logs, VT occurrence peaked between 6 AM and noon (P = .007 by ANOVA among four 6-hour time periods). Harmonic regression revealed a morning peak at 9 AM (P < .01). This morning peak occurred in patients with both frequent and infrequent events. Among 21 patients who experienced more than four VT events, 8 (38%) had an AM peak of VT occurrence (> 35% of VT between 6 AM and noon). Neither age, ejection fraction, event frequency, presenting arrhythmia, nor drug therapy distinguished patients who displayed the AM VT peak.
In patients with coronary artery disease, sustained VT displays circadian variation with peak frequency in the morning, similar to that for sudden death. Individual patients who display specific patterns of circadian variation over time can be identified using defibrillator logs. Investigation of circadian variation of other phenomena to elucidate mechanisms of VT should focus on these patients.
尽管先前利用流行病学数据和动态心电图监测的研究已表明，猝死和非持续性室性心动过速的发生高峰出现在早晨，但尚无研究探讨潜在致命性室性心动过速（VT）的昼夜变化，也没有研究纵向观察个体中任何心律失常的昼夜行为。我们利用多程控植入式心脏复律除颤器的事件记忆功能来评估持续性VT随时间的昼夜模式。
回顾了1991年5月至1993年8月期间连续32例患有冠心病且有持续性VT并接受Ventak PRX（CPI公司）心脏复律除颤器治疗、且至少经历过一次由该装置终止的VT发作的患者的数据。平均随访时间为14±7个月。在设备日志记录的2558次发作中，VT发作在上午6点至中午达到高峰（四个6小时时间段内通过方差分析，P = 0.007）。谐波回归显示上午9点出现高峰（P < 0.01）。这个早晨高峰出现在发作频繁和不频繁的患者中。在经历过四次以上VT发作的21例患者中，8例（38%）VT发作出现上午高峰（上午6点至中午之间的VT发作占> 35%）。年龄、射血分数、发作频率、初始心律失常或药物治疗均不能区分出现上午VT高峰的患者。
在冠心病患者中，持续性VT表现出昼夜变化，早晨发作频率最高，与猝死情况相似。利用除颤器日志可识别出随时间呈现特定昼夜变化模式的个体患者。为阐明VT机制而对其他现象的昼夜变化进行的研究应聚焦于这些患者。
