左房线性消融治疗阵发性心房颤动对心率变异性的影响

The effect of left atrium linear lesion encircling pulmonary veins on the heart rate variability

目的通过观察左房线性消融术治疗阵发性心房颤动(简称房颤)术后心率变异性(HRV)的变化来评价其对自主神经系统的影响。方法对25例行射频消融术的阵发性房颤患者,术前及术后第3天行24h动态心电图检查,分别测定最大心率,最小心率,平均心率;时域指标:RR间期标准差(SDNN),RR间期平均值的标准差(SDANN),相邻RR间期差的均方根(RMMSD),相邻RR间期差值超过50ms的RR间期所占百分数(PNN50);频域指标:低频功率(LF),高频功率(HF),低频高频比值(LF/HF)。结果患者术前最大心率,最小心率,平均心率,SDNN,SDANN,RMSSD,PNN50,LF,HF,LF/HF分别为151±41次/分,47±5次/分,70±9次/分,126±26ms,111±24ms,27±7ms,6±5ms,98±66ms2,86±119ms2,2.4±3.5;术后各指标分别为136±37次/分,66±8次/分,84±9次/分,57±17ms,53±17ms,16±7ms,2±3ms,18±19ms2,16±19ms2,1.2±1.6;手术前后各指标相比,差异有显著性(P均<0.05)。结论左房线性消融术后HRV降低,此可能是射频消融治疗房颤的机制之一。

Objective To evaluate the effect of left atrium linear lesion encircling pulmonary veins on the autonomic nervous system via the alternations of the heart rate variability（HRV）. Methods Twenty five patients with paroxysmal atrial fibrillation were referred for catheter ablation treatment. The left atrium linear lesion encircling pulmonary veins were done in every patients to achieve the disappearance of the pulmonary vein potentials. The maximal heart rate（MaxHR） , minimal heart rate（ MinHR）, mean heart rate （MeanHR）, time domain and frequency domain analyses of HRV were obtained by use of 24-hour ambulatory electrocardiogram before and 3 days after the procedure. Results The parameters of MaxHR, MinHR, MeanHR, SDNN, SDANN, RMSSD, PNN50, LF, HF, LF/HF were 151 ±41bpm,47 ±5 bpm,70 ±9 bpm, 126 ± 26 ms, 111 ± 24 ms ,27 ± 7 ms ,6 ± 5 ms ,98 ± 66 ms^2 ,86 ± 119 ms^2 ,2.4 ± 3.5 before the procedure , and 136 ±37 bpm ,66 ± 8 bpm,84 ± 9 bpm,57 ± 17 ms ,53 ± 17 ms, 16 ± 7 ms ,2 ± 3 ms, 18 ± 19 ms^2 , 16 ± 19 ms^2 , 1.2 ± 1.6 after the ablation （ P 〈 0.05 ）. Conclusion The left atrium linear lesion encircling pulmonary veins significantly alteres the HRV which might be one of the mechanism of catheter ablation of atrial fibrillation. [ Chinese Journal of Cardiac Pacing and Electrophysiology ,2007,21 （ 3 ） ：233 - 235]