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| The role of competitive mechanism of autonomic nerves in triggering atrial fibrillation after lobectomia pulmonalis |
| HE Geng-Xu, YAO Tong, WANG Chun-Guang, LIU Jun-Tang, LI Hai-Ying, CAI Bao-Song, PU Ren-Fu, ZHOU Feng, ZHANG Yan |
| (1.Department of Cardiovascular Thoracic Surgery, PLA No.251 Hospital; 2. Department of Electrocardiogram, the First Affiliated Hospital of North College, Zhangjiakou Hebei 075000, China) |
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Abstract Objective To evaluate the role of competitive mechanism of autonomic nerves in triggering atrial fibrillation（AF） after lobectomia pulmonalis. Methods Ambulatory electrocardiography(AECG) monitoring was carried out 24 hours before the operation and consecutively 96 hours after the operation on 281 patients over 60 who had received total pneumonectomy or lobectomia pulmonalis. For patients with appearance of AF, it was 2 hours before the operation, and 60 minutes, 30 minutes, and 5 minutes before the onset of AF when the heart rate variability(HRV) indices of AECG were analyzed. With an interval of 5 minutes chosen, the trend of HRV changes at the four time points before the onset of AF was studied, and so were tension variations of autonomic nerves and vagus. Results In 281 pneumonectomy patients, 48 was diagnosed with AF postoperatively, with an incidence of 17.1%. The indexes reflecting tension of vagus such as SDNN, rMSSD, pNN50, and HF all increased significantly, 60 minutes, 30 minutes, and 5 minutes before the onset of AF,however, the index of LF/HF which reflected the balance of autonomic nerves and parasympathetic was proned to descend gradually. The fact that the indexes of SDNN, rMSSD, pNN50, and HF increased significantly and the ratio of LF/HF decreased significantly 5 minutes before the onset of AF indicated a significant increase of vagus tension and a gradual decrease of RR interval before the onset of AF. Conclusion After lobectomia pulmonalis and before the onset of AF, there is a significant increase in HRV. Against the background of significantly increased autonomic nerves tension after lobectomia pulmonalis, the competitive increase of vagus tension may be an important mechanism of the onset of AF.
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2015, Vol. 24 
