特发性室性早搏经射频消融后自主神经系统活性的变化  

Changes of autonomic nervous system activity after radiofrequency ablation for idiopathic premature ventricular contraction

作　　者：丁兵[1] 戴允浪 何林燕 谢丽倩[2] Ding Bing;Dai Yunlang;He Linyan;Xie Liqian(Department of Cardiovascular Medicine,First Affiliated Hospital of Suzhou University,Suzhou 215006,China;不详)

机构地区：[1]苏州大学附属第一医院心血管内科,苏州215006 [2]苏州大学附属第一医院江苏省血液研究所,国家血液系统疾病临床医学研究中心,国家卫生健康委员会血栓与止血重点实验室,苏州215006

出　　处：《中国循证心血管医学杂志》2024年第1期82-87,共6页Chinese Journal of Evidence-Based Cardiovascular Medicine

摘　　要：目的射频导管消融术(RFCA)是特发性室性早搏(IPVC)的标准治疗方法。本研究旨在确定低、中、高负荷量的患者在RFCA术前术后的自主神经系统(ANS)活动。方法回顾性分析2017年6月至2021年3月共200例特发性室性早搏行射频消融手术的患者。在200例患者中,179例(89.5%)手术消融成功。将消融成功的患者分为低负荷组(负荷量≤15%)、中负荷组(负荷量15%~25%)和高负荷组(负荷量≥25%)。评估不同负荷和不同消融部位患者的临床数据、心率变异性(HRV)各参数、窦性心率震荡(HRT)及心率减速力(DC)。结果高负荷组的平均心率、5 min均值标准差(SDANN)、正常RR间期标准差(SDNN)、正常RR间期标准差(SDNN)指数、逐次R-R区间差异均方根(rMSSD)、相邻RR间期差值超过50 ms的RR间期所占百分数(pNN50)高于低负荷组,而低频功率(LF)/高频功率(HF)之比低于低负荷组。消融后,SDNN、SDNN指数、SDANN、rMSSD、pNN50、震荡斜率(TS)和DC显著降低(P<0.01),LF/HF和震荡初始(TO)显著升高(P<0.01)。术前早搏负荷与左心室舒张末期内径(LVEDd)、平均心率、SDNN指数、SDANN、rMSSD、pNN50呈正相关,与总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、左心室射血分数(LVEF)、LF/HF呈负相关。回归分析显示,特发性室性早搏负荷与平均心率(P<0.01)、SDANN(P<0.01)和rMSSD(P<0.01)呈正相关。结论随特发性室性早搏负荷增加,交感神经和迷走神经活动增强,并以交感神经活性增强为主。特发性室性早搏的发生可能与自主神经平衡调节受损有关。射频消融术可降低交感神经和迷走神经活性。Objective Radiofrequency catheter ablation(RFCA)is a standard therapy for idiopathic premature ventricular contraction(IPVC).To determine the preoperative and postoperative activities of autonomic nervous system(ANS)in patients received RFCA in low,medium and high loading.Methods IPVC patients(n=200)undergone RFCA were retrospectively analyzed from June 2017 to Mar.2021.Among 200 patients,there were 179 patients(89.5%)with successful RFCA.The patients with successful RFCA were divided into low-loading group(loading≤15%),mid-loading group(loading from 15%to 25%)and high-loading group(loading≥25%).The clinical data,parameters of heart rate variability(HRV),heart rate turbulence(HRT)and deceleration capacity of rate(DC)were reviewed in all groups with different RFCA sites.Results The mean heart rate(HRmean),SDANN,SDNN,index of SDNN,rMSSD and pNN50 all were higher,and radio of LF to HF(LF/HF)was lower in high-loading group than those in low-loading group.After RFCA,SDNN,SDNN index,SDANN,rMSSD,pNN50,TS and DC decreased significantly(P<0.01),and LF/HF and TO increased significantly(P<0.01).The preoperative IPVC loading was positively correlated to LVEDd,HRmean,SDNN index,SDANN,rMSSD and pNN50,and negatively correlated to TC,LDL-C,LVEF and LF/HF.The results of regression analysis showed that IPVC loading was positively correlated to HRmean(P<0.01),SDANN(P<0.01)and rMSSD(P<0.01).Conclusion With the increase of IPVC loading,both sympathetic and vagal nerve activities,mainly sympathetic nerve activities,are enhanced.IPVC occurrence may be related to impaired ANS balance regulation.RFCA can reduce the activities of both sympathetic and vagal nerves.

关 键 词：特发性室性早搏 导管射频消融 心率变异性 

分 类 号：R541.7[医药卫生—心血管疾病]