肥厚性心肌病合并心房颤动患者的心率变异性特点

摘要

Objective To explore the characteristics of heart rate variability ( HRV) in patients with hypertrophic cardiomyopathy (HCM) complicated with atrial fibrillation(AF). Methods A total of 98 patients with HCM were enrolled,including 20 patients complicated with AF( AF group) and 78 patients without AF( control group) . A total of 98 healthy volunteers were enrolled as normal group. All of the subjects underwent electrocardiography and color Doppler ultrasonography. HRV of the three groups was analyzed using 24-hour dynamic electrocardiogram. The indices of HRV consisted of the time domain indices[standard deviation of all normal sinus RR intervals(SDNN), mean of standard deviation of normal sinus RR intervals for all 5-minute segments( SDNNindex) ,root mean square of successive differences in normal to normal RR intervals( rMSSD) ,and percentage of normal RR-intervals with duration more than 50 ms different from the previous normal RR-interval(pNN50)] and frequency domain indices[low frequency(LF),high frequency(HF) and LF/HF)]. The AF group was divided into asymptomatic AF group(n=14) and symptomatic AF group(n=6) and the indices of HRV were compared between the two groups. Results Compared with the control group and the normal group,SDNN,SDNNindex,rMSSD,pNN50,LF and HF were significantly higher in the AF group(all P<0. 05). SDNN,SDNNindex and rMSSD in the symptomatic AF group were significantly higher than those in the asymptomatic AF group(all P<0. 05). Left arterial dimension increased and left ventricular ejection fraction decreased in the AF group compared to those in the normal group(all P<0. 05). There were no significant differences in all indices above between the normal group and the control group(P >0. 05). Conclusion Autonomic nerve dysfunction and increased vagal activity are found in patients with HCM complicated with AF,and it is more obvious in patients with symptomatic AF.%目的 探讨肥厚性心肌病(HCM)合并心房颤动(AF)患者的心率变异性(HRV)特征.方法 选择HCM患者98例,其中合并AF者(AF组)20例,不合并AF组(对照组)78例,另选取98例健康志愿者为正常组,均行心电图、心脏彩超,并采用24 h动态心电图方法分析3组间HRV的时域指标[全部正常窦性心搏R-R间期标准差(SDNN)、连续5 min正常R-R间期标准差的均值(SDNNindex)、全程相邻R-R间期之差的均方根值(rMSSD)、相邻的R-R间期之差大于50 ms的心搏数除以总的R-R间期的百分率(pNN50)]、频域指标[低频段(LF)、高频段(HF)、LF/HF].再将AF组分成无症状AF组14例与有症状AF组6例,比较两组的HRV指标.结果 与对照组以及正常组比较,AF组SDNN、SDNNindex、rMSSD、pNN50、LF、HF升高(均P<0.05);有症状AF组SDNN、SDNNindex、rMSSD较无症状AF组升高(均P<0.05).与正常组比较,AF组左房内径升高而左室射血分数降低(均P<0.05).正常组与对照组间以上指标比较差异均无统计学意义(均P>0.05).结论 HCM合并AF患者存在自主神经功能紊乱、迷走神经活性增高,而这一特点在有症状的AF患者中更显著.