The Study On Heart Rate Variability In Patients With Atrial Arrhythmia

BackgroundAtrial arrhythmia is a common arrhythmia, including atrial premature contraction, atrial tachycardia, atrial flutter and atrial fibrillation. Atrial arrhythmia can occur in healthy people, also can occur in organic disease patients. The autonomic nervous system dysfunction and arrhythmia development are closely related. Heart rate variability is a noninvasive detection method of an autonomic nervous system activity, reflects the tension and balance of cardiac sympathetic nerve and vagus nerve. Linear analysis of heart rate variability in paroxysmal atrial fibrillation is common, but heart rate variability analysis in atrial premature contraction, heart rate variability nonlinear analysis in paroxysmal atrial fibrillation is rare.Objectives1. To evaluate the autonomic function in atrial arrhythmia;2. To investigate whether there is a difference of autonomic nervous function in atrial arrhythmias patient between with and without organic heart disease;3. To investigate the significance of heart rate variability to the risk analysis of atrial premature contraction.4. To investigate the sensitive index of the heart rate variability in atrial arrhythmia.Methods1. Subjects:persons visited Shandong University Qilu Hospital from2011to2012 for dynamic electrocardiogram, total187cases, male81cases, female106cases, including the healthy control group, occasional atrial premature contraction without organic heart disease group, occasional atrial premature contraction with organic heart disease group, complex occasional atrial premature contraction without organic heart disease group, complex occasional atrial premature contraction with organic heart disease group and paroxysmal atrial fibrillation group.2. Instruments:Cardiovascular system state detector(CV FD-I(H)), Holter monitor and dynamic cardiograph analysis system.3. Procedure:The first step was history-talking. The second step was electrocardiac information recording in Holter monitor and in Cardiovascular system state detector at the same time. The third step was heart rate variability analysis.4. Statistical analysis:Samples of normal distribution and homogeneity of variance compared with ANOVA, samples of nonnormal distribution or heterogeneity of variance compared with Kruskal-Wallis H test by spss19.0. For all analysis, a P value less than0.05was considered significant.Results1. There weren’t difference in age structure, sex ratio and smoking ratio. The average heart rate and the slowest heart rate of the occasional atrial premature contraction without organic heart disease group reduced. The average heart rate of the occasional atrial premature contraction with organic heart disease group reduced. The slowest heart rate of the paroxysmal atrial fibrillation group reduced.2. The results of24hours heart rate variability1) The occasional atrial premature contraction without organic heart disease group: heart rate variability indexes were within normal limits.2) The complex occasional atrial premature contraction without organic heart disease group:compared with the control group, PNN50and RMSSD increased; compared with the occasional atrial premature contraction without organic heart disease group, SDNN index and RMSSD increased.3) The occasional atrial premature contraction without organic heart disease group: compared with the control group, PNN50reduced; compared with the occasional atrial premature contraction without organic heart disease group, PNN50reduced.4) The complex occasional atrial premature contraction with organic heart disease group:compared with the control group, PNN50reduced; compared with the complex atrial premature contraction without organic heart disease group, SDNN,SDNN index, RMSSD and PNN50reduced.5) The paroxysmal atrial fibrillation group:all indexes increased.2. The results of5minutes heart rate variability1) The occasional atrial premature contraction without organic heart disease group: indexes were within normal limits.2) The complex atrial premature contraction without organic heart disease group: indexes were within normal limits. Compared with the occasional atrial premature contraction without organic heart disease group, there weren’t differences.3) The occasional atrial premature contraction with organic heart disease group: Compared with the control group, HF, PNN50and Maximum Liapunov Exponent reduced. Compared with the occasional atrial premature contraction without organic heart disease group, LFnorm increased, HFnorm reduced, Maximum Liapunov Exponent reduced; Cardiac sympathetic index increased.4) The complex atrial premature contraction with organic heart disease group: Compared with the control group, Cardiac sympathetic index increased, HF, PNN50and Maximum Liapunov Exponent reduced. Compared with the complex atrial premature contraction without organic heart disease group, Cardiac sympathetic index increased, HF and PNN50reduced.5) The paroxysmal atrial fibrillation group:LFnorm reduced, HFnorm increased, MwEn and cardiac sympathetic index reduced.3. The correlation studies between the atrial premature contraction’s frequency and heart rate variability1) The correlation studies between the atrial premature contraction’s frequency and nonorganic heart disease group’s heart rate variability:In24hours heart rate variability,the positive correlations were observed between the atrial premature contraction’s frequency and RMSSD、PNN50、VLF、HF. In5minutes heart rate variability, the negative correlation was observed between the atrial premature contraction’s frequency and Maximum Liapunov Exponent.2) The correlation studies between the atrial premature contraction’s number and organic heart disease group’s heart rate variability:In24hours heart rate variability, the positive correlation was observed between the atrial premature contraction’s frequency and SDNN. In5minutes heart rate variability, the negative correlation was observed between the atrial premature contraction’s frequency and HF, Maximum Liapunov Exponent.Conclusion1. HRV in atrial premature contraction with organic heart disease reduced, HRV in atrial premature contraction without organic heart disease increased, HRV in paroxysmal atrial fibrillation increased. Atrial arrhythmia was closely related with vagus nervous dysfunction.2. The people who were atrial arrhythmia with organic heart diseases, vagus nerve hypofunction; without organic heart diseases, vagus nerve hyperfunction,At the same time,there were differences between the occasional atrial arrhythmia and the complex atrial arrhythmia.3. HRV could assist the risk assessment of atrial premature contraction.4. RMSSD, PN50, HF, HFnorm, LFnorm, Maximum Liapunov Exponent, Cardiac sympathetic index were sensitive indexes for atrial arrhythmia HRV.