Nagayoshi H, Janota T, Hnatkova K, Camm A J, Malik M
Department of Cardiological Sciences, St. George's Hospital Medical School, London, United Kingdom.
Am J Physiol. 1997 Apr;272(4 Pt 2):H1643-9. doi: 10.1152/ajpheart.1997.272.4.H1643.
This study investigated the changes in R-R interval in 23 patients (11 men and 12 women; mean age 61 yr) with persistent atrial fibrillation in response to several provocative maneuvers including active postural change, Valsalva maneuver, handgrip, and rhythm-controlled respiration. Averaged R-R intervals were shortened immediately after postural change (from 797 +/- 35 ms supine to 677 +/- 27 ms standing; P < 0.01) and recovered to the 90% level within 100 s. During Valsalva strain and handgrip, mean R-R intervals were significantly shortened (from 737 +/- 37 ms sitting to 697 +/- 38 ms in Valsalva and from 773 +/- 68 ms sitting to 701 +/- 58 ms in handgrip; both P < 0.01). During rhythm-controlled respiration, only two cases (10.5%) showed power peaks in spectrograms of moving-window-averaged R-R intervals at the frequency corresponding to respiration rhythm. The ventricular response to atrial fibrillation is influenced by an increase in sympathetic tone and a decrease in parasympathetic tone but is not necessarily influenced by the increase in parasympathetic dominance. These results suggest that even in atrial fibrillation patients, the autonomic nervous system modulates the ventricular rate via the atrioventricular node and atrial tissue.
本研究调查了23例持续性心房颤动患者（11例男性和12例女性；平均年龄61岁）在几种激发动作（包括主动体位改变、瓦尔萨尔瓦动作、握力动作和节律控制呼吸）后的R-R间期变化。体位改变后，平均R-R间期立即缩短（从仰卧位时的797±35毫秒缩短至站立位时的677±27毫秒；P<0.01），并在100秒内恢复至90%的水平。在瓦尔萨尔瓦动作用力和握力动作期间，平均R-R间期显著缩短（瓦尔萨尔瓦动作时从坐位的737±37毫秒缩短至697±38毫秒，握力动作时从坐位的773±68毫秒缩短至701±58毫秒；两者P<0.01）。在节律控制呼吸期间，仅2例（10.5%）在移动窗口平均R-R间期的频谱图中，于与呼吸节律对应的频率处出现功率峰值。心房颤动时的心室反应受交感神经张力增加和副交感神经张力降低的影响，但不一定受副交感神经优势增加的影响。这些结果表明，即使在心房颤动患者中，自主神经系统也通过房室结和心房组织调节心室率。
