Behrens S, Ehlers C, Brüggemann T, Ziss W, Dissmann R, Galecka M, Willich S N, Andresen D
Department of Cardiology and Pulmology, Klinikum Benjamin Franklin, Free University, Berlin, Germany.
Clin Cardiol. 1997 Mar;20(3):253-7. doi: 10.1002/clc.4960200313.
Sudden cardiac death exhibits a circadian variation and predominantly occurs during morning hours, Beta-adrenergic antagonists have shown to blunt this morning peak. However, previous reports studying the effects of beta blockers on the circadian variation did not analyze the underlying cause of sudden cardiac death. It thus remains unclear whether ventricular tachyarrhythmias are influenced by beta-blocker therapy.
This study tested the hypothesis that beta-blocking agents blunt the morning peak of life-threatening ventricular tachyarrhythmias.
In 87 patients who were treated and monitored with an implantable cardioverter defibrillator, the circadian distribution of ventricular tachyarrhythmias terminated by appropriate shocks was analyzed and compared in those receiving beta blockers versus those not receiving beta-blocker therapy.
Tachyarrhythmic episodes in the absence of beta-blocker therapy (n = 344) exhibited a circadian variation with a distinct morning peak (16, 38, 28, and 18% of episodes at 0-6, 6-12, 12-18, and 18-24 h, respectively, p < 0.001). In contrast, tachyarrhythmic episodes during beta-blocker therapy (n = 104) were equally distributed over time (22, 27, 24, and 27% of episodes at 0-6, 6-12, 12-18, and 18-24 h, respectively, p = 0.95). The circadian distribution of episodes was significantly different in patients with and those without beta blockade (p < 0.05).
Beta-adrenergic antagonists influence the circadian distribution of malignant ventricular tachyarrhythmias in patients with an implantable cardioverter defibrillator. The blunted morning peak of tachyarrhythmic events during beta blockade supports the hypothesis that a sympathetic surge is involved in the circadian pattern of malignant arrhythmias.
心源性猝死呈现昼夜节律变化，主要发生在早晨时段。β-肾上腺素能拮抗剂已被证明可减弱这种早晨高峰。然而，先前研究β受体阻滞剂对昼夜节律变化影响的报告并未分析心源性猝死的潜在原因。因此，尚不清楚室性快速性心律失常是否受β受体阻滞剂治疗的影响。
本研究检验了β受体阻滞剂可减弱危及生命的室性快速性心律失常早晨高峰的假设。
在87例接受植入式心律转复除颤器治疗和监测的患者中，分析并比较了接受β受体阻滞剂治疗的患者与未接受β受体阻滞剂治疗的患者中，通过适当电击终止的室性快速性心律失常的昼夜分布情况。
在未接受β受体阻滞剂治疗的患者中（n = 344），快速性心律失常发作呈现昼夜节律变化，有明显的早晨高峰（分别在0 - 6、6 - 12、12 - 18和18 - 24小时发作的比例为16%、38%、28%和18%，p < 0.001）。相比之下，在接受β受体阻滞剂治疗的患者中（n = 104），快速性心律失常发作随时间均匀分布（分别在0 - 6、6 - 12、12 - 18和18 - 24小时发作的比例为22%、27%、24%和27%，p = 0.95）。有β受体阻滞剂治疗和无β受体阻滞剂治疗的患者中发作的昼夜分布有显著差异（p < 0.05）。
β-肾上腺素能拮抗剂影响植入式心律转复除颤器患者恶性室性快速性心律失常的昼夜分布。β受体阻滞剂治疗期间快速性心律失常事件早晨高峰的减弱支持了交感神经兴奋参与恶性心律失常昼夜模式的假设。
