摘要目的 观察环肺静脉口部消融隔离治疗阵发性心房颤动(AF)术后心率及心率变异性(HRV)时域指标的长期变化.方法 共45例行射频消融术的阵发性AF患者,术前、术后第3天、术后1、3、6个月在本院行24 h动态心电图检查.分别测定平均心率(mean HR),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50 ms的RR间期所占百分数(PNN50).结果 共33例患者的动态心电图资料符合要求而纳入结果分析.其中男23例,女10例,年龄(59±10)岁,左心房直径(35±5)mm,左心室射血分数0.63±0.06.术后3 d,1、3、6个月mean HR较术前增快,差异有统计学意义.而HRV时域指标均出现减弱,部分指标如SDNN、SDANN在6个月时其变化仍然有统计学意义.是否进行右心房峡部消融对心率及HRV指标变化无影响.术中有无明显"去迷走神经"反射者之间差异也无统计学意义.结论 环肺静脉口部消融隔离术后平均心率增快,部分HRV时域指标减弱至少维持6个月.这种对自主神经系统的损伤作用可能是射频消融治疗AF的机制之一.

abstractsObjective To evaluate the long-term effect of circumferential pulmonary vein isolation (CPVI) on the cardiac automic system using the heart rate and heart rate variability. Methods Forty-five patients referred to catheter ablation for the paroxysmal atrial fibrillation were enrolled in the study. The CPVI at the pulmonary vein ostium was done in every patient. Before the procedure,3 days,1 ,3 ,and 6 months after the procedure,the patient received 24 h ambulatory electrocardiogram monitor ( Holter). The mean heart rate and the time domain analyses of HRV were obtained by the Holter. Results CPVI was successfully done in every patient. Thirty-three patients (23 males) meet the analysis criterion, with mean age of (59±10) years,mean left atrium diameter (35±5) mm,mean left ventricular ejection fraction 0. 63±0.06. Among them,8 patients accepted additional right atrial isthmus ablation,5 patients had suffered from vagal reflex in the procedure. The mean heart rate significantly increased in the post procedure period compared with that before the procedure (P <0.05). Significant 6 months of HRV attenuations were observed in SDNN and SDANN. However,the right atrial isthmus ablation as well as the vagal reflex did not have significant impact on the alteration of the heart rate and HRV. Conclusion CPVI significantly altered the heart rate and HRV in at least 6 months. It suggests that cardiac nervous system damage might be one of the mechanisms of catheter ablation for AF.