Wolpert C, Jung W, Spehl S, Schumacher B, Omran H, Schimpf R, Lüderitz B
Medizinische Klinik und Poliklinik, Rheinischen Friedrich-Wilhelms-Universität Bonn.
Dtsch Med Wochenschr. 1998 Feb 6;123(6):140-5. doi: 10.1055/s-2007-1023918.
Epidemiological studies have demonstrated a circadian distribution of sudden cardiac death (SD) and acute myocardial infarction (AMI), with a maximum frequency of events during the morning hours. Recently an analysis of computer recordings of implanted cardioverter/defibrillators has confirmed these findings with respect to SD. The majority of these studies concerned patients with coronary heart disease. In a prospective study we evaluated the circadian and weekly distribution of malignant ventricular tachyarrhythmias (VTA) in patients with a nonischaemic cardiac disease, namely dilated cardiomyopathy (CMP), and those with coronary heart disease (CHD).
Over a mean period of 25 +/- 9 months computer-stored data and cardiac electrograms recorded from the implanted cardioverter/defibrillators (ICD) were analysed in 28 patients with CHD and 11 with DCMP. The circadian and weekly distribution of VTA was obtained, using customary arrhythmia classification and the stored and timed events.
Patients with CHD had a maximal frequency of VTA or ventricular fibrillation (VF) during the morning, with a peak between 9 and 10 o/c, while those with DCMP were at a higher risk of VTA or VF in the later afternoon and early evening. Regarding the frequency of events during the week, a significantly higher incidence of VTA was recorded on Saturdays in those with CHD, but on Mondays and Wednesdays in those with DCMP.
The circadian and weekly distribution of VTA differs significantly between patients with CHD and those with DCMP. A possible reason for this difference may be different trigger mechanisms in the two types of cardiac disease, since transient ischaemia is unlikely to be the cause in patients with nonischaemic DCMP.
流行病学研究表明，心源性猝死（SD）和急性心肌梗死（AMI）具有昼夜分布规律，早晨时段事件发生频率最高。最近，一项对植入式心脏复律除颤器计算机记录的分析证实了关于心源性猝死的这些发现。这些研究大多涉及冠心病患者。在一项前瞻性研究中，我们评估了非缺血性心脏病（即扩张型心肌病，CMP）患者和冠心病（CHD）患者恶性室性心律失常（VTA）的昼夜和每周分布情况。
在平均25±9个月的时间里，对28例冠心病患者和11例扩张型心肌病患者植入式心脏复律除颤器（ICD）记录的计算机存储数据和心脏电图进行了分析。采用常规心律失常分类以及存储的定时事件，得出VTA的昼夜和每周分布情况。
冠心病患者VTA或心室颤动（VF）的发生频率在早晨最高，9点至10点之间达到峰值，而扩张型心肌病患者在下午晚些时候和傍晚早期发生VTA或VF的风险更高。关于一周内事件的发生频率，冠心病患者在周六记录到的VTA发生率显著更高，而扩张型心肌病患者在周一和周三发生率更高。
冠心病患者和扩张型心肌病患者VTA的昼夜和每周分布存在显著差异。这种差异的一个可能原因可能是两种类型心脏病的触发机制不同，因为短暂性缺血不太可能是非缺血性扩张型心肌病患者的病因。
