| Objective:To observe the change of autonomic nervous through analysising the heart rate variability (HRV) in patients with paroxysmal atrial fibrillation(PAF), and investigate the relationship between autonomic nervous regulation and PAF.Methods:72 cases of patients with PAF were randomly assigned to the observed group.69 patients with no abnormal physical examination were taken as control group. The total 141 cases took the examination of 24 hour dynamic electrocardiogram (DCG). According to time duration(TD) of PAF capturing during DCG monitoring in all PAF cases, the observed group was further divided into three subgroups:group1 TD< 60min, group2 TD 60-240min, group3 TD> 240min. And set up the sinus rhythm stage of 30min before and after the on set of PAF,5min after the restoration of sinus rhythm after 1 hour in each subgroup, named A, B andC fragment. The A, B fragments were divided into 6 zones in each 5min unit and named A1-A6 zone and B1-B6 zone according to the time sequence. A6 zone was the 5min sinus region close to initial department of the atrial fibrillation fragment (AF pattern, AFp), and B1 zone was 5min sinus region close to the termination 3f AFp. Measuring HRV of all the subjects in each period:using HRV time domain indexes, including SDNN, SDANN and RMSSD to analysis the whole (24 hours) of ECG data; frequency domain index, i.e low frequency power (LF) and high frequency power (HF) were used to analysis the A1-A6 zone,B1-B6 zone and C fragment (5min) of the HRV ECG. The measuring HRV indexes were showed with x+s. Eventurally using the corresponding statistical analysis to evaluate the the HRV trend of different periods before and after PAF attacking by comparing the HRV indexes in all groups, and speculate the changes of the autonomic nervous system function in regulating the PAF.Result:1, Compared the long HRV index of observation group and control group using t-test, showing:Two indexes(SDNN, RMSSD) of the observation group were significantly higher than the control group (P<0.05), the SDANN index of observation group was indifference to the control group (P>0.05). Illustrating that the activity of the vagus nerve in PAF patients may have significantly enhanced compare to the healthy populations.2, Applying ANOVA to analysis the HRV frequency domin index of A6 zone before PAF attacking in the three subgroups, showing that LF and HF indexes in group 1 were higher than that in group 2 (P<0.05), LF and HF indexes in group 2 were higher than in group 3(P<0.05). The analysis of HRV frequency domain indexes of B1 region after PAF attacking in those three subgroups demonstrated that LF and HF values in group 1 are higher than that in group 2 (P<0.05), LF and HF values in group 2 were higher than in group 3(P<0.05). HRV frequency domain index of C fragment in three subgroups showed that LF and HF values in group 1 were higher than that in group 2 (P<0.05), LF and HF values in group 2 were higher than in group 3 (P<0.05).So we get the conclusion that among the A6,B1>C regions before and after PAF attacking, when TD is shorter, LF and HF index is higher; and TD is longer, LF and HF index is lower.Compared with the control group, showing:In the A6, LF and HF values in group land 2 were higher than the control group (P< 0.05), LF and HF values in group 3 were indifference to the control group (P>0.05).In the B1, LF and HF values in group land HF values in group 2 were higher than the control group (P< 0.05), LF and HF values in group 3and LF values in group 2 were indifference to the control group (P>0.05).In the C, LF and HF values in group 1 and 2 were indifference to the control group (P>0.05),LF and HF values in group 3 were lower than the control group (P<0.05)3,The variation of HRV index from A1 zone to the A6 zone in A segment of each subgroup, using ANOVA, illustrated that LF and HF indexes from A1 to A4 zone showed an increasing trend in group 1(P<0.05), A4 to A6 zone showed a decreasing trend(P<0.05). The LF and HF values in group 2 and group3 had a waves change (P>0.05).4, Analysis the HRV frequency domin index of A6 zone and B1 zone attacking in the three subgroups, showing:in group 1,LF indexes of B1 zone was higher than that of A6 zone(P<0.05), HF indexes of B1 zone was lower than that of A6 zone(P<0.05); in group 2, LF and HF indexes of B1 zone was lower than that of A6 zone(P<0.05); in group3, LF and HF indexes of B1 zone was indifference to that of A6 zone(P>0.05).5, The variation of HRV indexes from B1 zone to B6 zone in B segment was that LF and HF indexes in group 1 and group2 was decreasing(P<0.05). In group 3, LF and HF indexes had no obviously tendency and showed fluctuations changes (P>0.05). Applying ANOVA to analysis the HRV frequency domin index of B1 zone and C zone attacking in the three subgroups, showing:LF and HF indexes of C zone was lower than that of B1 zone in the three groups(P<0.05).Conclusion:1,The occurrence and development of PAF (TD<240min) is related to the regulation arrhythmia of cardiac autonomic nervous system. The PAF patients often accompany an abnormal increasing of anterior vagus modulation before attacking and it may be associated with the occurrence of PAF.2,The duration of PAF (TD<240min) may concern to the abnormal regulation of autonomic nerve before and after of PAF, which performanced as that the sympathetic activity is increasing and the activity of the vagus nerve is decreasing in patients (TD<60min),the sympathetic activity is abnormally decreasing and the activity of the vagus nerve is decreasing in patients (TD60-240min).3, after the end of PAF,autonomic nervous activity in Patients (TD<240min) returns to normal.4,It prompts that patients (TD>240min) the occurrence and development of PAF isnot related to the regulation arrhythmia of cardiac autonomic nervous system. In the pathogenesis of PAF, there may be the participation of other mechanisms,except the autonomic nerve. |
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