Frost L, Mølgaard H, Christiansen E H, Jakobsen C J, Allermand H, Thomsen P E
Hjertemedicinsk afdeling B, Skejby Sygehus, Arhus.
Ugeskr Laeger. 1996 Jul 1;158(27):3919-23.
To investigate the impact of pre-operative autonomic balance and atrial ectopic activity on the risk of atrial fibrillation or flutter after aorto-coronary artery bypass surgery 24-hour Holter monitoring was analyzed in 102 patients before coronary artery bypass grafting. Index for vagal tone was calculated as % successive RR-interval differences > 6%. Twenty-nine (28%) of the 102 patients developed atrial fibrillation or flutter. Independent predictors (90% confidence interval) of postoperative atrial fibrillation or flutter were identified by logistic regression analysis: the independent predictors were older age, relative risk 1.07/year (1.02-1.12), vagal index < 10%, relative risk 4.50 (1.40-14.5), > or= 10 ectopic supraventricular beats/24 hour, relative risk 3.03 (1.05-8.72), and one or more event of non-sustained supraventricular tachycardia, relative risk 3.02 (1.11-8.22). Thus, age of the patient, attenuated preoperative cardiac vagal modulation, ectopic supraventricular beats, and paroxysmal non-sustained supraventricular tachycardia are independent risk factors for the development of atrial fibrillation or flutter after coronary artery bypass surgery.
为研究术前自主神经平衡和房性异位活动对主动脉冠状动脉搭桥手术后房颤或房扑风险的影响，对102例患者在冠状动脉搭桥术前进行了24小时动态心电图监测分析。迷走神经张力指数计算为连续RR间期差异>6%的百分比。102例患者中有29例（28%）发生房颤或房扑。通过逻辑回归分析确定了术后房颤或房扑的独立预测因素（90%置信区间）：独立预测因素为年龄较大，相对风险为1.07/年（1.02 - 1.12），迷走神经指数<10%，相对风险为4.50（1.40 - 14.5），≥10次异位室上性搏动/24小时，相对风险为3.03（1.05 - 8.72），以及一次或多次非持续性室上性心动过速事件，相对风险为3.02（1.11 - 8.22）。因此，患者年龄、术前心脏迷走神经调节减弱、异位室上性搏动和阵发性非持续性室上性心动过速是冠状动脉搭桥手术后发生房颤或房扑的独立危险因素。
