Andresen D, Brüggemann T
Department of Cardiology, Urban Hospital Berlin, Germany.
J Cardiovasc Electrophysiol. 1998 Aug;9(8 Suppl):S26-9.
The purpose of this article is to discuss the relationship between sympathovagal dysfunction and the occurrence of paroxysmal atrial fibrillation. Onset of atrial fibrillation is subject to circadian variation; shorter episodes occur more frequently during the day, whereas longer episodes occur less frequently at night. Vagally mediated atrial fibrillation typically is preceded by bradycardia, is not triggered by stress, occurs more often at night, is more common in men, and occurs at a younger age. Sympathetically mediated atrial fibrillation is less frequent, typically occurs during the day, can be triggered by stress, and often is accompanied by increasing sinus rate and frequent supraventricular extrasystoles. Determination of heart rate variability can be used to evaluate the effects of the autonomic nervous system on sinus rate. The onset of atrial fibrillation at night may be preceded by an increase in high-frequency components of heart rate variability. This is not the case for episodes that occur during the day. The heart rate in sympathetically mediated atrial fibrillation is higher before and during the episode in comparison with the vagal type. Heart rate variability is a promising method for evaluation of the interplay of sympathetic and vagal activity before the onset of atrial fibrillation. However, the role of heart rate variability for diagnostic assessment and therapeutic decision-making in patients with paroxysmal atrial fibrillation remains to be clarified by controlled studies.
本文旨在探讨交感迷走神经功能障碍与阵发性心房颤动发生之间的关系。心房颤动的发作存在昼夜变化；较短发作在白天更频繁出现，而较长发作在夜间较少出现。迷走神经介导的心房颤动通常在心动过缓之前出现，不是由压力触发，在夜间更常发生，在男性中更常见，且发病年龄较轻。交感神经介导的心房颤动较少见，通常在白天发生，可由压力触发，且常伴有窦性心率增加和频繁的室上性期前收缩。心率变异性的测定可用于评估自主神经系统对窦性心率的影响。夜间心房颤动发作前可能出现心率变异性高频成分增加。白天发作的情况则并非如此。与迷走神经型相比，交感神经介导的心房颤动发作前及发作期间心率更高。心率变异性是评估心房颤动发作前交感神经和迷走神经活动相互作用的一种有前景的方法。然而，心率变异性在阵发性心房颤动患者诊断评估和治疗决策中的作用仍有待对照研究予以阐明。
