Lok N S, Lau C P
Department of Medicine, Queen Mary Hospital, Hong Kong.
Pacing Clin Electrophysiol. 1998 Feb;21(2):386-95. doi: 10.1111/j.1540-8159.1998.tb00062.x.
The aim of this study was to evaluate the cardiovascular autonomic function and vasovagal reaction in patients with paroxysmal atrial fibrillation without significant structural heart disease. Twenty-eight patients with paroxysmal atrial fibrillation (9 patients were categorized to have autonomic-mediated atrial fibrillation while atrial fibrillation in other patients was nonautonomic mediated) and 19 normal control subjects were recruited. Cardiovascular autonomic function tests included measuring heart rate response to standing, deep breathing, Valsalva maneuver, baroreflex sensitivity, 24-hour heart rate variability, and also head-up tilt test. Compared with normal subjects, no significant autonomic dysfunction was found in patients with autonomic-mediated and nonautonomic-mediated atrial fibrillation. All subjects had negative baseline tilt test. With isoproterenol provocation, six patients developed atrial fibrillation. Four of 9 patients and 3 of 19 patients with autonomic mediated and nonautonomic mediated atrial fibrillation had a positive tilt test respectively, while none occurred in the controls. A significant percentage (32%) of patients with paroxysmal atrial fibrillation had episodes of atrial fibrillation provoked by changes in autonomic tone, although there was no underlying abnormal cardiac autonomic function nor sympathetic-parasympathetic imbalance. A heightened susceptibility to vasovagal cardiovascular response may have important implications on the occurrence and symptomatology of patients with paroxysmal atrial fibrillation.
本研究旨在评估无明显结构性心脏病的阵发性心房颤动患者的心血管自主神经功能及血管迷走反应。招募了28例阵发性心房颤动患者（9例归类为自主神经介导的心房颤动，其他患者的心房颤动为非自主神经介导）及19名正常对照者。心血管自主神经功能测试包括测量站立、深呼吸、瓦尔萨尔瓦动作、压力反射敏感性、24小时心率变异性时的心率反应，以及头高位倾斜试验。与正常受试者相比，自主神经介导和非自主神经介导的心房颤动患者均未发现明显的自主神经功能障碍。所有受试者基线倾斜试验均为阴性。使用异丙肾上腺素激发后，6例患者发生心房颤动。自主神经介导和非自主神经介导的心房颤动患者中，9例中的4例和19例中的3例倾斜试验呈阳性，而对照组无一例阳性。尽管没有潜在的心脏自主神经功能异常或交感 - 副交感神经失衡，但相当比例（32%）的阵发性心房颤动患者的心房颤动发作由自主神经张力变化诱发。血管迷走性心血管反应的易感性增加可能对阵发性心房颤动患者的发生及症状具有重要影响。
