青年军人显著性窦性心动过缓的无创性电生理研究

A non-invasive clinical electrophysiological study on obvious sinus bradycardia in young military personnel

目的观察青年军人显著性窦性心动过缓(OSB)临床电生理特点。方法采用常规及24小时动态心电图、经食管心房调搏、阿托品试验等无创检查观察青年军人中有症状(a组)、无症状(b组)OSB患者及健康志愿者(c组)各30例。结果a、b、c组早期复极综合征患者分别为9、8、2例(a、b与c组比较P<0.05);a、b 2组平均心率<60次/m in且显著低于c组(P<0.01),a、b 2组间平均心率、最慢心率、最快心率差异均无显著性。a、b、c组心率变异性时域指标及频域指标高频成分递减。经食管心房调搏示a、b 2组迷走神经张力增高,但注射阿托品后与c组比较无统计学差异。3组阿托品试验均阴性,但达峰值心率时间a组明显慢于b、c 2组(P<0.01)。结论青年军人OSB患者电生理改变与高迷走神经张力有关,对迷走神经改变反应性慢可能为其不适症状的原因之一。

AIM To explore the clinical electrophysiological characteristics of young military personnel with obvious sinus bradycardia （OSB）, which is defined as rest heart rate less than 50 beats per minute （bpm）. METHODS Thirty symptomatic （group a） and 30 asymptomatic （group b） young military personnel with OSB, along with 30 volunteer without OSB from the same troop （group c）, aged 18 -25 years, were evaluated by noninvasive means of electrocardiograph （ECG）, 24 hours ambulatory monitor, atropine ECG test and trans-esophageal atrium pacing （TEAP）. RESULTS We found 9, 8 and 2 cases with early repolarization syndrome in group a, b and c respectively （ compared with group c, P 〈 0.05 ）. No significant difference was found in mean, maximum and minimum heart rate between group a and b. The mean heart rate in group a and b was less than 60 bpm and significantly slower than that in group c （ P 〈0.01 ）. The index of heart rate variety （HRV） analysis indicated that HRV significantly declined in a descending order from group a, b to c （P 〈0.01 ）. Atropine ECG test and TEAP revealed higher vagus tension in group a and b than that in group c. No statistic difference after atropine injection was found among the 3 groups. Atropine ECG tests were negative in all three groups and the time to peak heart rate in group a was longer than that in group b and c （compared with group a, P 〈0.01 ）. CONCLUSION The electrophysiological change in young military personnel with OSB is related with high vagus tension and slow reaction to the changes of the tension may contribute to these symptoms.