Paroksismal Atriyal Fibrilasyonun Öngördürücüleri: Kalp Hızı Değişkenliği ve Kalp Hızı Türbülansı

Abstract

Amaç: Otonomik disfonksiyon, atriyal fibrilasyon (AF) gelişmesine ve tekrarlamasına en büyük sebep olan faktörlerden biridir. Risk faktörleri olan hastalarda kalp hızı değişkenliği (KHD) ve kalp hızı türbülansı (KHT) gibi otonomik disfonksiyon parametrelerini kullanarak AF’yi tahmin etmek günlük pratiğimizi etkileyebilir. Bu çalışmada, paroksismal AF (PAF) hastaları ve sağlıklı denekler arasında 24 saatlik Holter EKG’den elde edilen KHD ve KHT ölçümlerini karşılaştırmayı amaçladık. Materyal ve Metot: Bu vaka-kontrol çalışmasına toplam 116 hasta dahil edildi. Tüm hastalara 24 saatlik Holter EKG monitörizasyonu yapıldı. KHD (VLF, LF, HF, SDNN, SDANN, ASDNN, rMSSD, pNN50) ve KHT parametreleri [türbülans başlangıcı (TO) ve türbülans eğimi (TS)] analiz edildi ve gruplar arasında karşılaştırıldı. Tüm katılımcılar KHT parametrelerine göre üç gruba ayrıldı (KHT-0: normal TO, TS; KHT-1; anormal TO veya TS; KHT-2: anormal TO ve TS). Bulgular: PAF’lı hastalarda tüm KHD parametrelerinin bozulduğu bulundu (tüm parametreler için p<0,05). TO (PAF: 1,23±2,56; kontrol: -1,02±1,35; p= <0,001) ve TS (PAF: 2,59±2,39; kontrol: 3,75±1,49; p=0,002) değerlerinde gruplar arasında istatistiksel olarak anlamlı fark vardı. Ayrıca PAF hastalarının %62’si HRT-2 grubunda iken sağlıklı denekler ağırlıklı olarak HRT-0 grubundaydı (%79). Sonuç: Anormal KHD ve KHT değerleri, artan PAF riskini yansıtabilir. Hem TS hem de TO bozuk olan hastalar yakından izlenmelidir. AF’nin olası komplikasyonları, invaziv olmayan, tekrarlanabilir, kolay erişilebilir 24 saatlik EKG Holter monitörizasyonu kullanılarak erken teşhis ve uygun tedavi ile önlenebilir.

Keywords

• otonomik disfonksiyon
• kalp hızı değişkenliği
• kalp hızı türbülansı
• paroksismal atriyal fibrilasyon

Predictors of Paroxysmal Atrial Fibrillation: Heart Rate Variability and Heart Rate Turbulence

Abstract

Aim: Autonomic dysfunction is one of the major contributors to atrial fibrillation (AF) development and recurrence. Predicting AF using autonomic dysfunction parameters such as heart rate variability (HRV) and heart rate turbulence (HRT) in patients with risk factors may influence our daily practice. Thus we compare HRV and HRT measurements derived from 24 hours Holter ECG between paroxysmal AF (PAF) patients and healthy subjects. Material and Method: A total number of 116 patients were included in this case-control study. All patients underwent a 24-h Holter ECG monitoring. HRV (VLF, LF, HF, SDNN, SDANN, ASDNN, rMSSD, pNN50) and HRT parameters [turbulence onset (TO) and turbulence slope (TS)] were analyzed and compared between groups. According to their HRT parameters, all participants were divided into three groups (HRT-0: normal TO, TS; HRT-1; abnormal TO or TS; HRT-2: abnormal TO and TS). A p-value <0.05 was considered significant. Results: All HRV parameters were impaired in patients with PAF (p<0.05 for all parameters). There was a statistically significant difference between groups in TO (PAF 1.23±2.56; control -1.02±1.35; p= <0.001) and TS (PAF 2.59±2.39; control 3.75±1.49; p=0.002) values. In addition, 62% of the PAF patients were in HRT-2 group, on contrary; healthy subjects were predominantly in HRT-0 group (79%). Conclusion: Abnormal HRV and HRT values may reflect an increased risk of PAF. Patients should be closely monitored when both TS and TO are impaired. AF’s potential complications may be prevented by early detection and proper treatment using non-invasive, reproducible, easily accessible 24-h ECG Holter monitoring.

Keywords

• autonomic dysfunction
• heart rate variability
• heart rate turbulence
• paroxysmal atrial fibrillation

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