房颤射频消融术后复发的心率变异比较分析

Recurrent heart rate variability after radiofrequency ablation for atrial fibrillation:A comparative analysis

目的探讨自主神经系统与射频消融术后复发的关系。方法 2011年2月-2012年8月在解放军总医院心内科行左房环肺静脉消融术治疗阵发性房颤的患者82例,均接受三维标测系统(CARTO)指导下左房环肺静脉电隔离射频消融术。分别在术前3 d、术后3 d、术后3、6、12个月及以后每6个月定期随访,并进行12导联动态心电图(Holter)监测,根据术后3 d的结果将患者分为房颤早期复发组(34例)和未复发组(48例);并根据3个月后的随访结果将患者分为房颤晚期复发组(22例)和无复发组(60例)。分别记录早期、晚期复发组与未复发组患者的平均心率(MeanHR)及心率变异(heart ratevarability,HRV),进行比较分析,包括时域指标R-R间期的标准差(SDNN)、R-R间期平均值的标准差(SDANN)、相邻R-R间期差的均方根(rMSSD)、相邻R-R间期差值超过50 mm的N-N间期所占百分数(PNN50),频域指标低频功率(lowfrequency,LF)、高频功率(high frequency,HF)、低频与高频功率比值(LF/HF)。结果 82例患者均达到肺静脉电隔离。术后未复发组与复发组比较,早期MeanHR降低,HRV指标均显著降低,LF/HF升高;晚期仅有反应迷走神经的指标显著降低,LF/HF升高。结论迷走神经的持续降低可有效地减少房颤的晚期复发。

Objective To study the relation between autonomic nerve system （ANS） and recurrent atrial fibrillation （AF） after radiofrequency ablation （RA）. Methods Eighty-two paroxysmal AF patients who underwent circumferential pulmonary vein ablation （CPVA） under CARTO system guidance in Department of Cardiology, Chinese PLA General Hospital, from February 2011 to August 2012, were included in this study. The patients were followed up for 6 months 3 days before operation and 3 days, 3, 6 and 12 months after operation, and received 12-lead ambulatory Holter monitoring. The patients were divided into early AF recurrence group （n=34）, non- AF recurrence group （n=48） according to their condition 3 days after operation, and into late AF recurrence group （n=22） and non-late AF recurrence group （n=60） according to the findings during the 3 months follow-up after operation. The mean heart rate （HR） and heart rate variability （HRV） in early and late AF recurrence groups, such as SDNN, SDANN, rMSSD, PNN50, LF, HF, and LF/HF, were recorded and analyzed. Results The mean HR, HRV and vagus nerve tone were significantly lower whereas the LF/HF was significantly higher in non- AF recurrence group than in AF recurrence group. Conclusion Persistent low vagus nerve tone can effectively prevent late AF recurrence.