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目的:观察心房颤动(atrial fibrillation,AF)发作前后心率变异性(heart rate variability,HRV)频阈指标的变化以探讨自主神经系统的张力变化在AF发作中的作用。方法:2005年1月～2007年12月在南京医科大学第一附属医院就诊的阵发性AF患者共17例满足分析条件,行24h动态心电图检查,对动态心电图资料进行离线分析,分别选取AF发作前5min和发作后1h的5min时段进行HRV的频阈指标分析。结果:共有27阵AF满足分析条件。总体上AF发作前后频阈指标无显著性变化。将AF发作时间分成日间组15阵和夜间组12阵,统计表明两组之间并无显著性差别。但是AF发作前后的HRV频阈指标变化可分为2种类型:第1种A型为LF以及LF/HF增加,而HF下降(LF12.3±9.6vs22.4±14.1,P=0.0002;LF/HF0.9±0.5vs2.5±2.0,P=0.004;HF15.9±13.9vs12.1±11.7,P=0.003);第2种B型为LF及LF/HF下降,而HF增加(LF29.5±26.7vs7.4±6.1,P=0.04;LF/HF4.4±3.1vs0.6±0.5,P=0.02;HF6.5±1.5vs16.3±9.3,P=0.02)。这种神经张力改变的类型有一定的发作时段特异性,即A型更多发生于夜间,而B型更多发生于日间,但是未达统计学差异(P=0.07)。结论:AF发作前后均伴随HRV频阈指标的变化,这种变化可分为两种类型,可能分别代表了交感和迷走两神经系统张力的变化。并且这种变化显示出一定的时间特异性趋势。
OBJECTIVE: To observe the change of threshold value of heart rate variability (HRV) before and after atrial fibrillation (AF) in order to investigate the role of autonomic nervous system changes in AF. Methods: From January 2005 to December 2007, 17 patients with paroxysmal AF who were treated in the First Affiliated Hospital of Nanjing Medical University met the requirements of the analysis. The ambulatory electrocardiogram was performed 24 hours. The electrocardiogram data were analyzed offline. AF The 5 min before the attack and 1 h after the attack 5 min period HRV frequency threshold analysis. Results: A total of 27 AF met the analysis conditions. Before and after the general AF episode frequency threshold index no significant change. The AF episodes were divided into 15 groups of daytime group and 12 group of nighttime group. Statistics showed that there was no significant difference between the two groups. However, the change of HRV threshold before and after AF can be divided into two types: the first type A is LF and LF / HF increases, while the HF decreases (LF12.3 ± 9.6 vs22.4 ± 14.1, P = 0.0002; LF /HF0.9 ± 0.5vs2.5 ± 2.0,P=0.004; HF15.9 ± 13.9vs12.1 ± 11.7,P = 0.003); the second type B was LF and LF / HF decreased, while HF increased (LF29 .5 ± 26.7 vs 7.4 ± 6.1, P = 0.04; LF / HF 4.4 ± 3.1 vs 0.6 ± 0.5, P = 0.02; HF 6.5 ± 1.5 vs. 16.3 ± 9.3, P = 0.02). This type of change in neuronal tone has a certain seizure-period specificity, that is, type A occurs more frequently in the night, whereas type B occurs more frequently in the daytime, but with no statistical difference (P = 0.07). CONCLUSION: The changes of HRV threshold before and after AF may be divided into two types, which may represent the changes of the nervous system tension of sympathetic and vagal, respectively. And this change shows some time-specific trends.