目的：探讨阵发性房颤（PAF）患者环肺静脉消融术前后心率变异性（HRV）的动态改变及其与术后复发的关系。方法：选择行左房环肺静脉电隔离射频消融术治疗阵发性房颤的患者108例，根据术后3d和3个月的12导联动态心电图分为房颤早期复发组（10例）、晚期复发组（21例）和无复发组（77例）。随访并比较各组患者 H R V的变化。结果：与射频术前比较，射频术后3d未复发组24h正常RR间期标准差（SDNN）、24h每5min正常RR间期平均值标准差（SDANN）、相邻正常RR间期差值的均方根（rMSSD）、低频（LF）、高频（HF）均显著降低；早期复发组术后平均心率显著增加，SDNN、LF、LF／HF显著降低（P＜0.05或＜0.01）；与未复发组比较，早期复发组平均心率[（69.3±11.2）次／min比（75.4±14.0）次／min]、SDANN[（66.9±25.7）ms比（137.5±92.3）ms]、rMSSD[（22.1±10.6）ms比（46.2±19.2）ms]、LF[（233.1±31.4）ms比（251.7±17.3）]、HF[（228.0±82.4） ms2比（508.0±13.5） ms2]显著增加，LF／HF[（1.13±0.53） ms2比（0.41±0.13） ms2]降低更显著（P＜0.05或＜0.01）；与未复发组比较，晚期复发组rMSSD[（23.9±11.10） ms2比（52.0±28.7） ms2]和HF[（344.4±103.2） ms2比（482.1±100.6） ms2]明显升高，LF／HF[（1.16±0.41）比（0.85±0.43）]明显降低（P＜0.05或 P＜0.01）。结论：降低迷走神经张力，可能会减少阵发性房颤患者环肺静脉消融术后的复发。%Objective:To explore dynamic change of heart rate variability (HRV) before and after circumferential pulmonary vein ablation (CPVA ) in patients with paroxysmal atrial fibrillation (PAF) and its relationship with postoperative recur‐rence .Methods:A total of 108 PAF patients undergoing left atrial circumferential pulmonary vein electrically isolated ra‐diofrequency ablation were selected .According to 12‐lead DCG on 3d and three months after operation ,patients were di‐vided into early recurrence group (n=10) ,late recurrence group (n=21) and no recurrence group (n=77) .HRV changes were followed up and compared among all groups .Results:Compared with before ablation ,on 3d after ablation ,there were significant reductions in standard deviation of normal to normal RR intervals calculated over the 24 h period (SDNN) , standard deviation of normal to normal RR intervals in all 5 min segments of the entire recording (SDANN) ,root‐mean square of differences betweensuccessive normal to normal intervals (rMSSD) ,low frequency (LF) ,high frequency (HF) in no recurrence group ;significant rise in mean heart rate ,and significant reductions in SDNN ,LF and LF/HF in early recur‐rence group ( P< 0.05 or <0.01);compared with no recurrence group ,there were significant rise in mean heart rate [(69.3 ± 11.2) beats/min vs .(75.4 ± 14.0) beats/min] ,SDANN[(66.9 ± 25.7)ms vs .(137.5 ± 92.3)ms] ,rMSSD [(22.1 ± 10.6)ms vs .(46.2 ± 19.2)ms] ,LF [(233.1 ± 31.4)ms vs .(251.7 ± 17.3)]and HF[(228.0 ± 82.4) ms2 vs . (508.0 ± 13.5) ms2 ] ,and significant reduction in LF/HF[(1.13 ± 0.53) ms2 vs .(0.41 ± 0.13) ms2 ]in early recurrence group (P<0.05 or < 0.01);significant rise in rMSSD [(23.9 ± 11.10) ms2 vs .(52.0 ± 28.7) ms2 ]and HF[(344.4 ± 103.2) ms2 vs .(482.1 ± 100.6) ms2 ] ,and significant reduction in LF/HF[(1.16 ± 0.41) vs .(0.85 ± 0.43)]in late recur‐rence group , P<0. 05 or <0. 01. Conclusion:Vagal tone reduction may reduce recurrence after CPVA in PAF patients .
展开▼
