Yamashita T, Murakawa Y, Hayami N, Sezaki K, Inoue M, Fukui E, Omata M
The Second Department of Internal Medicine, Faculty of Medicine, University of Tokyo, Japan.
Am J Cardiol. 1998 Dec 1;82(11):1364-7. doi: 10.1016/s0002-9149(98)00642-0.
The purpose of this study was to determine whether aging influences the circadian variation of nonvalvular paroxysmal atrial fibrillation (AF). Among 31,200 consecutive Holter monitorings recorded between January 1988 and March 1997, we detected 212 patients who had paroxysmal AF in a drug-free state. These patients were divided into 2 groups according to their age: < or = 60 years old (94 patients) and >60 years old (118 patients). In each group, the sum of the duration of each AF episode and the probability of onset, maintenance, and termination of AF were determined as hourly data and compared between the 2 groups. The time distribution of AF showed remarkable age dependence, with a well-modulated and monophasic circadian rhythm in the younger group in contrast to a toneless triphasic rhythm in the older group. Among the onset, maintenance, and termination of the arrhythmia, the most obvious age-dependence was observed in the circadian variation of onset. In the younger group, there were triple peaks with the highest one in the night, whereas the older group exhibited a single peak in the daytime. In contrast, the probabilities of maintenance and termination showed similar circadian patterns between the groups, although their amplitudes were significantly reduced in the older group. Thus, aging significantly influenced the circadian variation of paroxysmal AF, with the most prominent effect on its onset, leading to more random time-distribution of AF with increasing age. These results extend to paroxysmal AF the concept that aging disrupts rhythmicity, suggesting age-dependent differences in its pathophysiology.
本研究的目的是确定衰老是否会影响非瓣膜性阵发性心房颤动（AF）的昼夜节律变化。在1988年1月至1997年3月期间连续记录的31200次动态心电图监测中，我们检测到212例处于无药状态的阵发性AF患者。这些患者根据年龄分为两组：≤60岁（94例）和＞60岁（118例）。在每组中，将每次AF发作的持续时间总和以及AF发作、维持和终止的概率确定为每小时数据，并在两组之间进行比较。AF的时间分布显示出明显的年龄依赖性，年轻组呈现出良好调节的单相昼夜节律，而老年组则呈现出无明显特征的三相节律。在心律失常的发作、维持和终止中，在发作的昼夜节律变化中观察到最明显的年龄依赖性。在年轻组中，有三个峰值，最高峰值出现在夜间，而老年组在白天呈现一个峰值。相比之下，维持和终止的概率在两组之间呈现出相似的昼夜模式，尽管老年组的幅度明显降低。因此，衰老显著影响阵发性AF的昼夜节律变化，对其发作的影响最为突出，导致随着年龄增长AF的时间分布更加随机。这些结果将衰老破坏节律性的概念扩展到阵发性AF，提示其病理生理学存在年龄依赖性差异。
