Fries R, Heisel A, Jung J, Stopp M, Schieffer H, Ozbek C
Medizinische Klinik Innere Medizin III, Kardiologie Gebäude 40 Universitätskliniken des Saarlandes Oscar-Orth-Strasse
Z Kardiol. 1996 Feb;85(2):140-7.
The purpose of this study was to analyze temporal patterns of spontaneous ventricular tachyarrhythmias in patients (p) with implantable cardioverter-defibrillator (ICD). By reading out the ICD-data logs 725 arrhythmic episodes (e) from 43 patients were investigated. After grouping the episodes into four defined time periods (period 1: midnight to 6 a.m., period 2: 6 a.m. to noon, period 3: noon to 6 p.m., period 4: 6 p.m. to midnight) according to the data stored by the device, the percentage of episodes per time period has been calculated for each patient who experienced at least 10 arrhythmic events (n = 22). A significant peak occurrence (mean 34%) could been demonstrated for the morning hours (period 2). Analyzing patients individually, 4 subgroups could be identified: group 1 with an episode peak in period 2 (9 p, 277 e, p < 0.01), group with an episode peak in period 3 (4 p, 83 e, p < 0.01), group 3 with a peak occurrence in period 4 (3 p, 110 e, p < 0.01) and group 4 with an equal episode distribution over all four time periods (6 p, 187 e). Comparing sustained and nonsustained tachyarrhythmias, the nonsustained episodes were found to be distributed much more equally, meanwhile the circadian variation for fast (HR > or = 240/min) and slower (HR < 240/min) arrhythmias was identical. Regarding episodes of patients on beta-blocker or class III-antiarrhythmic therapy the same circadian variation has been found. There was no significant difference between the subgroups of patients with an episode peak in period 2 and the other patients concerning age, sex, cardiac disease, left ventricular ejection fraction, clinical arrhythmia, beta-blocker or class III-antiarrhythmics, number of recorded episodes or follow-up time. Further studies are needed to determine a possible correlation between these findings and different circadian variations in individual psychovegetative activity.
本研究的目的是分析植入式心脏复律除颤器（ICD）患者自发性室性快速心律失常的时间模式。通过读取ICD数据日志，对43例患者的725次心律失常发作进行了研究。根据设备存储的数据将发作分为四个特定时间段（时间段1：午夜至上午6点，时间段2：上午6点至中午，时间段3：中午至下午6点，时间段4：下午6点至午夜）后，计算了每位经历至少10次心律失常事件的患者（n = 22）每个时间段发作的百分比。结果显示上午时段（时间段2）出现显著的发作高峰（平均34%）。对患者个体进行分析时，可识别出4个亚组：第1组在时间段2发作高峰（9例患者，277次发作，p < 0.01），第2组在时间段3发作高峰（4例患者，83次发作，p < 0.01），第3组在时间段4发作高峰（3例患者，110次发作，p < 0.01），第4组在所有四个时间段发作分布均匀（6例患者，187次发作）。比较持续性和非持续性快速心律失常，发现非持续性发作分布更为均匀，同时快速（心率≥240次/分钟）和慢速（心率<240次/分钟）心律失常的昼夜变化相同。对于接受β受体阻滞剂或Ⅲ类抗心律失常治疗的患者发作情况，也发现了相同的昼夜变化。在时间段2发作高峰的患者亚组与其他患者在年龄、性别、心脏病、左心室射血分数、临床心律失常、β受体阻滞剂或Ⅲ类抗心律失常药物、记录发作次数或随访时间方面无显著差异。需要进一步研究以确定这些发现与个体心理植物神经活动中不同昼夜变化之间的可能关联。
