[AF-FORUM] 83E 房颤心律变异性的分析. Dr. Lombardi

[AF Symposium]

关于房颤病人速度表的心率变异性分析是一个较长时 
间的难题。我们知道，尤其当我们想了解神经调节机 
制时候，在条件控制情况下短时间的光谱分析是可以 
提供充分的信息的。但是，对于低频与高频成分的生 
理分析比预想的要复杂。尤其对于房颤病人分析只能 
限于心室率的情况下更是存在争议。因为它不反映窦 
性活动，且有多种神经和非神经因素参与。其中呼吸 
运动是主要因素，这也是为什么当年一篇描述房颤患 
者呼吸活动相关特点的文章在Circulation上发表的原 
因。在我看来，房颤患者RR间期的分析根本不能同窦 
率患者一样提供自主神经特点信息。它可以提供关于 
呼吸的影响，不同药物对房室结的作用，以及心室对 
应的反应。例如，我们曾报道在阵发性房颤患者自动 
恢复窦率之前，并没有发现RR间期变异性的变化。这 
种心律变化情况下自主神经不发生变化进而心率变异 
性没有变化是不合理的。有可能的是，非线性动态分 
析或非线性速度表方法可以对波群分析提供有益的信 
息，但对自主神经控制机制的信息可能仍较小。

Federico Lombardi, MD, FESC, FHRS.
federico.lombardi在unimi.it


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Re: [AF-FORUM] 83E Evaluation of HRV in AF. Dr. Lombardi
The issue of applying HRV analysis to tachogram of patients in AFib
is a long one with difficult solution. It is well known that
particularly when we want to obtain information on neural modulatory
mechanisms, spectral analysis of short term recordings under
controlled conditions provides adequate information. Nevertheless
also in this condition the physiological interpretation of LF and HF
component is more complex than originally suggested. The issue is
more controversial when considering AF patients where the analysis is
restricted to ventricular response that does not reflect sinus
activity but is the results of a complex interaction of neural and
non-neural factors. Among them respiration ( with all hemodinamic,
mechanical and neural changes) in a major one. This may explain why
several year ago  a paper describing the results of respiration
related activity in AF patients was published on Circulation.
In my opinion, the analysis of RR interval in A Fib patients cannot
provide the same information than in pts in sinus rhythm particularly
in relation to autonomic modulation.
It may offer information on the effects of respiration and of
different drugs on AV node filter function and ventricular response.
For example, we reported that before spontaneous recovery of sinus
rhythm in patients with paroxysmal A Fib, no changes in RR
variability or coefficient of variations were detectable. It is
unlikely that in this rhythm transition autonomic mechanisms did not
play a major role but HRV failed to give some indication. It is
possible that non linear dynamic methodology might offer interesting
information on the complexity or non linear characteristics of the
tachogram, but again little information autonomic control mechanisms
Federico Lombardi, MD, FESC, FHRS.
federico.lombardi在unimi.it

--
Dr. Sergio Dubner
President of Scientific Committee

Dr. Edgardo Schapachnik
President of Steering Committee