索他洛尔对室性心律失常患者心率变异性的影响

目的：探计索他洛尔对室性心律失常（ＶＲ）患心率变异性（ＨＲＶ）的影响。方法：２０例ＶＲ服用索他洛尔（８０ｍｇ，每日２次）。２Ｗ，测定用工前后的２４ｈ的ＨＲＶ的时域指标，并与３０例正常人比较。结果：ＶＲ的ＨＲＶ各指标均低于正常人，治疗后ＨＲＶ各指标较治疗前增高，并与正常对照组比较无显性差异。结论：ＶＲ交感神经活性增强，副交感神经活性降低，ＨＲＶ程度降低，索他洛尔可改善ＶＲ的ＨＲＶ。     

索他洛尔对室性早搏患者心率变异性的影响

目的　通过观察室性早搏患者在用索他洛尔治疗前后室性早搏及HRV的变化 ,以了解索他洛尔对室性早搏及HRV的影响。方法　对 5 0例室性早搏病人在索他洛尔治疗前后用动态心电图时域分析法对心率变异性各项指标进行了检测 ,并与对照组 5 0例进行比较。结果　与对照组进行比较 ,代表心率总变异程度的SDNN、SDANNI和SDNNI明显下降 (P <0 0 1) ,代表迷走神经功能的指标rMSSD、pNN5 0也有下降 (P <0 0 5 )。治疗组用药后与用药前比较显示对室性早搏有效率 70 % ,HRV的SDNN、SDANNI、SDNNI、rMSSD和 pNN50 均有所下降 (P <0 0 5 )。结论　索他洛尔不但能减少室性早搏 ,改善症状 ,而且能提高心率变异性 ,改善预后。     

室性心律失常患者心率变异性研究

目的探讨冠心病与非冠心病室性心律失常患者心率变异性的差异。方法选自2011年1月至2013年10月于我院行24h动态心电图检查的患者560例。按照患者24h动态心电图室性心律失常的类型、数目、形态及有无冠心病分为5组：健康对照组143例;简单室早非冠心病组100例;简单室早冠心病组102例;复杂室早非冠心病组106例;复杂室早冠心病组109例;各组年龄构成比、男女比例无显著差异。所有患者均进行24h心率变异性检测,并对检测结果进行分析。结果比较这五组患者的24h心率变异性时域分析指标,非冠心病室早组心率变异性时域分析指标增高;冠心病室早组心率变异性时域分析指标降低。室早冠心病组与非冠心病组24h心率变异性时域分析指标有显著差异。结论 24h心率变异性时域分析对于室早的危险分层、科学处理、合理治疗有重要意义,心率变异性时域分析是一项在室早诊疗过程中有价值的辅助检查。     

脑出血患者期前收缩与心率变异性改变的关系

对５２例脑出血急性期患者的心率变异性（ＨＲＶ）进行了观察，并对室性期前收缩（室早）及室上性早搏（室上早）的发生情况与ＨＲＶ的关系进行分析。结果表明，室早Ｌｏｗｎ氏分级Ⅱ级Ⅱ级以上、室上早频发及短四室上束宫物ＨＲＶ明显低于早搏偶发或无早搏患者，提示脑出血患者植物神经功能受损，其心律失常的严重程度与植物神经功能受损的程度呈正相关。     

心率变异性与冠状动脉病变的关系

本研究对８８例行冠状动脉动脉造影检查的患者，于造影前１周进行心率变异性检查，以了解自主神经功能与冠状动脉病变的关系。结果；１。冠状动脉单支病变，双支病变有三支病变之间ＨＲＶ时域及频域指标有下降趋势，但无统计学意义；２．ＨＲＶ与冠状动脉病变部位，病变程度不相关；３．心率与左室     

应用24小时动态心电图评价冠心病心率变异性（摘要）

应用２４小时动态心电图评价冠心病心率变异性（摘要）路方红，吕东玲，阮景纯，孙晓玲，吴思群近年来心率变异性（ＨＲＶ）作为反映心脏自主神经状况的无创性指标，日益得到关注。本文应用２４小时动态心电图检测ＨＲＶ时域指标，旨在探讨冠心病心肌梗死患者ＨＲＶ检测的...     

索他洛尔治疗心律失常对QT离散度的影响

目的：以下可达龙与索他洛尔进行比较，用ＱＴ离散度（ＱＴｄ）来评价索他洛尔致心律失常的作用。方法：索他洛尔２０例，可达龙１０例，剂量分别为４０～１６０ｍｇ／ｄ对２００～６００ｍｇ／ｄ共１２周，服药前后，用标准１２导联用同步心电图和Ｈｏｌｔｅｒ测量ＱＴｄ等指标来评价分析。结果：两组ＨＲ，ＱＴ，室早，房早均有显著性的临床意义（Ｐ〈０．０１），ＱＴｃ可达龙组较索他洛尔组有一定延长（Ｐ〈０．０５），ＱＴｄ两     

正常人心率变异性时域分析和频域分析的相关性

正常人心率变异性时域分析和频域分析的相关性刘霞本文在正常人中比较心率变异性（ＨＲＶ）时域和频域二种分析方法的相关性，目的是为临床上评定提供帮助。方法分析对象共１００例，男性７９例，女性２１例，平均年龄４５９±１１６岁（１５－６９）。来自健康体检无...     

急性心肌梗死心率变异性与临床背景的关系

分析８４例急性心肌梗死（ＡＭＩ）后两周患者的心率变异性（ＨＲＶ），旨在了解ＡＭＩ后ＨＲＶ与临床资料的关系。结果：１．ＨＲＶ各项指标与年龄呈负相关，女性患者的ＨＲＶ较男性低（Ｐ＜０．０５）。２．ＨＲＶ与左室射血分数、心肌梗死部位及是否合并高血压无明显关系，但糖尿病患者时域指标中的Ｓｔ．ｇｅｏｒｇｅｓ指数较无糖尿病患者显著下降（Ｐ＜０．０１）。３．心室晚电位阳性者的ＨＲＶ时域指标ＳＤ、Ｓｔ．ｇｅｏｒｇｅｓ指数较阴性者显著下降（Ｐ＜０．０５）。结论：年龄、性别、晚电位及糖尿病对ＨＲＶ有影响     

原发性高血压左室肥厚与心率变异性相关研究与苯那普利治疗

目的探讨原发性高血压左室肥厚时心律失常以及心率变异的相关性及苯那普利的治疗作用。方法采用彩色多普勒结合心率变异性（ＨＲＶ）对高血压有或无心室肥厚患者进行分析并观察苯那普利的治疗作用。结果左室肥厚组２４小时室性早搏（ＶＰＣ）高于无肥厚组，Ｌｏｗｎ级别亦增加，苯那普利治疗后心室厚度指数减少，早搏及Ｌｏｗｎ分级降低。心率变异性（ＨＲＶ）时域分析表明ＬＶＨ组各指标均较无肥厚组降低，但只有均数有显著性。ＨＲＶ非线性散状图亦有呈显著性差别。而在苯那普利治疗后两组均有显著性差异。结论苯那普利对高血压病人的心率变异性的改变有明显的治疗作用。尤其是高血压有左室肥厚及严重心律失常者更为有利     

Effect of sotalol on heart rate variability assessed by Holter monitoring in patients with ventricular arrhythmias

Reduced vagal activity has been demonstrated to be associated with an increased risk of sudden death. Assessing the heart rate variability as a measure of the autonomic control of the heart has been established as a useful tool for the risk stratification of patients after myocardial infarction. In the current study, heart rate variability assessed by time- and frequency-domain measures was determined from Holter recordings before and during treatment with sotalol in 28 patients wtth chronic ventricular arrhythmias. The heart rate variability at baseline was independent of the presence or absence of spontaneous arrhythmias and of left ventricular function. Therapy with sotalol produced a significant improvement over control values in indices of parasympathetic tone (root mean square of the difference in successive RR intervals, proportion of adjacent RR intervals different by > 50 msec, high-frequency power spectrum). This improvement was not related to drug-induced changes in the mean heart rate or the suppression of ventricular ectopic activity. These effects on heart rate variability may contribute significantly to the overall efficacy profile of sotalol.     

Linear and non-linear dynamics of heart rate variability in brain dead organ donors

Recent studies outlined linear and non-linear dynamics in heart rate variability; however, their physiological origin is still unknown. The present study investigated the impact of cerebral function on linear and non-linear dynamics in heart rate variability. Electrocardiograms from seven brain dead organ donors and seven healthy volunteers were analyzed. Atropine was used in healthy volunteers to adjust their heart rate to that of the donors. As compared to healthy volunteers without atropine, the linear dynamics of heart rate variability, determined by time and frequency domain analyses, were significantly reduced in healthy volunteers with atropine and, to an even greater extent, in donors. Atropine tended to increase the complexity and non-linearity of heart rate variability in healthy volunteers, as determined by the correlation dimension D and the largest Lyapunov exponent L, respectively (D = 9.43 +/- 2.93 vs. 7.65 +/- 0.97 and L = 0.525 +/- 0.099 vs. 0.504 +/- 0.047 bits.beat-1; both NS), while these indices were significantly reduced in donors by 19.5 +/- 12.8% and 15.0 +/- 11.7%, respectively (D = 6.16 +/- 0.98 and L = 0.428 +/- 0.059 bits.beat-1; both p < 0.05 vs. volunteers). Thus, loss of cerebral function reduces both linear and non-linear components of heart rate variability.     

Anti-arrhythmic therapy: diagnostic possibilities of signal-averaged electrocardiography and heart rate variability

Effects of monotherapy with class IC, II and III antiarrhythmic drugs on parameters of signal averaged (SA) ECG and heart rate variability were studied in 88 patients (mean age 45.6+/-7.8 years). Class IC drugs (ethacizine, disopyramide) caused worsening of qualitative parameters of SA ECG and appearance of ventricular late potentials. Therapy with beta-adrenoblockers, amiodarone and sotalol in patients with ventricular arrhythmias was associated with improvement of parameters of SA ECG, lowering of sympathetic and augmentation of parasympathetic activity without sings of arrhrythmogenic and negative inotropic effects. Combination of noninvasive diagnostic methods including SA ECG, temporal and spectral analysis of heart rate variability, Holter ECG monitoring can facilitate selection of appropriate antiarrhythmic therapy and control of its efficacy.     

索他洛尔对运动时QTc和JTc间期的影响

目的探讨生理运动状态下索他洛尔对心室复极作用的影响。方法以随机、双盲、索他洛尔、普萘洛尔和安慰剂进行自身对照,对30例入选的健康志愿者,进行活动平板运动试验;对体表心电图上校正的QT间期(QTc)和校正的JT间期(JTc)进行分析。结果与服普萘洛尔和安慰剂比较,静息状态时索他洛尔对QTc和JTc的延长作用最显著。运动过程中,服索他洛尔、普萘洛尔和安慰剂的QTc和JTc都缩短,其中服索他洛尔的JTc缩短最显著,其JTc的缩短率(ΔJTc%)大于服普萘洛尔和安慰剂(8.83%±6.09%vs2.70%±6.20%和5.73%±5.83%,P<0.001和P<0.05)。并且运动过程中服索他洛尔的ΔJTc%与运动心率呈显著正相关(r=0.148,P<0.01)。结论索他洛尔显著延缓静息状态下的心室复极,在运动过程中与普萘洛尔和安慰剂比较,索他洛尔延缓心室复极的作用呈现出进行性减弱的现象。     

Linear and non-linear dynamics of heart rate variability in brain dead organ donors

Recent studies outlined linear and non-linear dynamics in heart rate variability; however, their physiological origin is still unknown. The present study investigated the impact of cerebral function on linear and non-linear dynamics in heart rate variability. Electrocardiograms from seven brain dead organ donors and seven healthy volunteers were analyzed. Atropine was used in healthy volunteers to adjust their heart rate to that of the donors. As compared to healthy volunteers without atropine, the linear dynamics of heart rate variability, determined by time and frequency domain analyses, were significantly reduced in healthy volunteers with atropine and, to an even greater extent, in donors. Atropine tended to increase the complexity and non-linearity of heart rate variability in healthy volunteers, as determined by the correlation dimension D and the largest Lyapunov exponent L, respectively (D=9.43±2.93 vs. 7.65±0.97 and L=0.525±0.099 vs. 0.504±0.047 bits·beat^–1; both NS), while these indices were significantly reduced in donors by 19.5±12.8% and 15.0±11.7%, respectively (D=6.16±0.98 and L=0.428±0.059 bits·beat^–1; both p<0.05 vs. volunteers). Thus, loss of cerebral function reduces both linear and non-linear components of heart rate variability.     

Studies of arrhythmia incidence and heart rate variability in patients with stable angina pectoris

Continuous Holter ECG monitoring is a valuable, easy to perform, non-invasive method of assessing not only cardiac arrhythmias but also heart rate variability and autonomic nervous system function. The aim of the study was to determine cardiac arrhythmias and HRV in patients with stable angina with and without previous myocardial infarction. 156 patients, 92 with and 64 without previous myocardial infarction, were examined. The control group consists of 50 healthy volunteers of the same age and sex. No pharmacological treatment except nitroglycerin was applied 2 days before and during examination, blood electrolytes were normal and 24-hour activity was the same in both examined groups. Heart rate variability was assessed by calculation of indices based on statistical operations on RR intervals (time-domain analysis). As a result of the study it was found out that in patients with stable angina pectoris cardiac arrhythmias occur more often and 24-hour heart rate variability is depressed as well as during daily activity and night resting than in healthy persons. In patients without previous myocardial infarction it was found out that 24-hour heart rate was slower than in patients with previous myocardial infarction, which depended mainly on slower heart rate during night, heart rate variability was not significantly different between these groups.     

Poor reproducibility of parameters of heart rate variations]

The analysis of heart rate variability is supposed to be a marker of autonomic cardiac activity and is used for risk stratification of post-infarction patients. Analysis of heart rate variability in the frequency domain may permit a differentiation of vagal and sympathetic control; for such analyses only short time intervals characterized by a steady-state autonomic balance can be used. Yet, it is unclear whether single determinations of heart rate variability indices derived from short time intervals yield reproducible results. Therefore, the reproducibility of heart rate variability indices was studied with weekly measurements in 10 healthy volunteers under the following defined conditions: 13 min supine rest, 10 min standing, 13 min sitting, and 15 min cycle ergometry followed by a 14 min recovery period. Heart rate variability was determined in the frequency domain (fast Fourier transformation) and in the time domain. The reproducibility was estimated by the coefficient of variation (CV). Additionally, the reproducibility of heart rate, blood pressure, and the expiratory-inspiratory ratio of heart rate was determined. The reproducibility of the frequency domain indices (36.6-74.9% CV) and of the time domain indices (19.6-32.8% CV) was considerably worse than that of heart rate (5.2-8.2% CV), blood pressure (5.1-8.2% CV) and the expiratory-inspiratory ratio of heart rate (4.6% CV). The reproducibility of heart rate variability indices was not improved by orthostatic or ergometric challenge. This poor reproducibility does not permit a reliable interpretation of heart rate variability on the basis of single measurements in healthy volunteers. Given the wide range and scatter of the measured parameters, the diagnostic and prognostic value of heart rate variability indices derived from short recording periods appears questionable.     

Influence of autonomic tone on the filtered QRS duration from signal averaged electrocardiograms in healthy volunteers

We recently reported that signal averaged electrocardiograms (SAECG) measurements possess a circadian rhythm and are closely related to heart rate or heart rate variability in healthy volunteers. This study determines the influence of autonomic tone on the filtered QRS (f-QRS) duration from SAECG by using pharmacologic autonomic blockade and exercise in healthy volunteers. Eleven healthy male volunteers were studied. Three protocols were designed to study the effects of exercise (Ex) under control conditions, beta adrenergic blockade or double blockade. SAECGs and heart rate variability (LF and HF: low and high frequency power, LF/HF ratio) were determined from Holter recordings. Ex significantly decreased the f-QRS duration and HF and significantly increased heart rate and LF/HF. Ex during beta adrenergic blockade significantly increased heart rate and decreased f-QRS duration and HF, but did not change LF/HF. Ex during double blockade did not affect the f-QRS duration, HF, or LF/HF. The changes in f-QRS duration induced during Ex, autonomic blockade, or both were inversely correlated with changes in heart rate and LF/HF and positively correlated with changes in HF. These data suggest that f-QRS duration in healthy subjects is shortened by Ex with increased sympathetic tone or decreased parasympathetic tone or the combination.     

Autonomic Function in Patients with Functional Dyspepsia Assessed by 24-Hour Heart Rate Variability

The function of the autonomic nervous system was assessed in 23 patients with dysmotility-like functional dyspepsia and 12 healthy volunteers by analysis of 24-hr heart rate variability and a battery of five standardized sympathetic and parasympathetic cardiovascular reflex tests. Measures of heart rate variability were obtained by analysis of ambulatory electrocardiographic recordings using both the time and the frequency domain methods. The values of parameters reflecting vagal activity (HF, rMSSD) were significantly lower in patients with functional dyspepsia. Individual analysis of heart rate variability data identified at least one abnormal parameter of vagal function in seven (30.4%) patients, and in five of these the results of parasympathetic cardiovascular reflex tests were also abnormal. Our results suggest impaired efferent vagal function in a subgroup of patients with functional dyspepsia. This abnormality may play a role in the pathogenesis of the disease in these patients.     

Sotalol vs metoprolol for ventricular rate control in patients with chronic atrial fibrillation who have undergone digitalization: a single-blinded crossover study.

AIMS: To compare the effects of sotalol and metoprolol on heart rate, during isotonic (ITE) and isometric (IME) exercise and daily activities, in digitalized patients with chronic atrial fibrillation. METHODS AND RESULTS: The study had a randomized, single-blinded, crossover design. Twenty-three patients with chronic atrial fibrillation received placebo for 4 weeks, followed by a 4-week period of treatment with sotalol and metoprolol in random order. At the end of each period, the patients were assessed with 24-h ECG monitoring, a cardiopulmonary exercise test and a handgrip manoeuvre. Both agents produced a lower heart rate than placebo at rest and at all levels of isotonic exercise (P < 0.001) without affecting oxygen uptake. Sotalol produced a lower heart rate than metoprolol only at submaximal exercise (116 +/- 9 bpm for sotalol vs 125 +/- 11 bpm for metoprolol, P < 0.001). During isometric exercise, sotalol produced a lower maximum heart rate than did metoprolol (113 +/- 22 vs 129 +/- 18 bpm, respectively). Both agents produced a lower mean heart rate than placebo over 24 h (P < 0.001 for all), while sotalol produced a lower mean heart rate than metoprolol during the daytime (P < 0.01). CONCLUSION: Sotalol is a safe and effective agent for control of heart rate in digitalized patients with atrial fibrillation. Sotalol is superior to metoprolol at submaximal exercise, resulting in better rate control during daily activities.