心率变异性分析与首次行植入式心脏转复除颤器植入早期事件的关系

Correlation between heart rate variability and early events in patients underwent first implantation of implantable cardioverter-defibrillator

目的 探讨心率变异性各参数和首次植入植入式心脏转复除颤器（ICD）后早期事件次数及治疗次数的关系,评估其预测价值.方法 回顾性分析2012年1月至2015年10月于我院行ICD植入患者共56例,其中男性31例,女性25例.所有患者植入ICD之前行动态心电图检查,从时域及频域分析心率变异性.3月后对患者进行ICD程控,根据有无ICD事件分为事件组和对照组.分析两组心率变异性指标与ICD记录事件次数及治疗次数的关系.结果 事件组共17人.事件组24h窦性心搏RR间期的标准差（SDNN）小于对照组（87.4±13.3比101.3±23.1,P=0.025）,经过logistic校正之后差异有统计学意义.事件组中SDNN与抗心动过速次数（ATP）呈负相关,r=-0.508（P=0.037）.SDNN对ATP事件预测ROC曲线下的面积为0.705（P=0.015）,对电击事件的ROC曲线下面积为0.812（P=0.002）.结论 首次植入ICD患者术前SDNN越低,3月后ICD事件次数及治疗次数越多.SDNN显示了良好的早期ICD事件预测价值,值得推广.

Objective To investigate the correlation between the parameters of heart rate variability （HRV）and the times of early events and treatments in patients underwent the first implantation of implantable cardioverter-defibrillator（ICD）,and to evaluate its predictive value. Methods A total of 56 patients,who underwent ICD implantation in our hospital between January 2012 and October 2015,were retrospectively analyzed,including 31 males and 25 females. All patients underwent dynamic electrocardiography （ECG） examination before the ICD implantation,and the HRV was assessed both in the time domain and frequency domain. The ICD program control was performed at 3 months. All patients were divided into the event group and control group according to whether there were ICD events. The correlation between the parameters of HRV and the times of recorded ICD events and treatments was analyzed. Results There were 17 patients in the event group. The SDNN of 24 h sinus beats during the RR interval in the event group was less than that in the control group （87.4±13.3 vs 101.3±23.1,P=0.025）,and there was statistically significant differences the logistic correction. There was a negative correlation between SDNN and anti-tachycardia pacing（ATP）in the event group,r=-0.508 （P=0.037）. The SDNN-predicted area under the ROC curve was 0.705 for ATP events（P=0.015）and 0.812 for shock events（P=0.002）. Conclusion The lower the SDNN before the first implantation of ICD in patients,the more the times of ICD events and treatments after 3 months. SDNN shows a good predictive value of early ICD events and justifies widespread use.