心跳變異生理回饋對冠心病合併早發性心室收縮病人之療效

The Effects of Heart Rate Variability Biofeedback on Patients with Coronary Artery Disease and Premature Ventricular Contractions

背景及目的：冠狀動脈疾病（coronary artery disease, CAD）有75%合併早發性心室收縮（premature ventricular contraction, PVC），合併PVC的病人相較於未合併者有較高機率發生突發性心臟死亡；此外，生氣情緒與CAD病人有較高的PVC發生率有關。研究證實心跳變異生理回饋（heart rate variability biofeedback, HRV-BF）在心血管疾患之療效。本研究目的探討HRV-BF是否可降低CAD合併PVC病人在休息狀態與生氣情緒下之PVC發生次數。方法：本研究治療組接受常規醫療與每週一小時共六週的HRV-BF；控制組接受常規醫療。兩組參與者在前測與後測各進行五分鐘基準期、中性陳述期與中性恢復期、生氣陳述期與生氣恢復期之心電圖測量，並計算PVC發生次數。結果：在前測，治療組與控制組在基準期、生氣陳述期與生氣恢復期之PVC發生次數無顯著的組間差異。在後測，兩組在PVC發生次數達顯著交互作用，Bonferroni事後比較發現治療組在基準期、生氣陳述期與生氣恢復期無顯著階段差異，但控制組在生氣陳述期的PVC發生次數顯著高於生氣恢復期。此外，治療組在後測生氣陳述期之PVC發生次數顯著低於前測，但控制組前測與後測之PVC發生次數無顯著差異。結論：HRV-BF藉由提升感壓反射（baroreflex）、迷走神經與自主神經系統活性，改善CAD合併PVC病人之PVC發生次數，此非侵入性的心理介入可做為輔助常規醫療的介入方案。 Background and Purpose: Approximately 75% of patients with coronary artery disease (CAD) have comorbid premature ventricular contraction (PVC), and patients with PVC are at a higher cardiac mortality risk than those without PVC. Anger has been found to be associated with high incidence rates of PVC in patients with CAD. The effects of heart rate variability biofeedback (HRV-BF) on cardiovascular diseases have been confirmed. The purpose of this study was to examine the effects of HRV-BF on reducing the incidence of PVC among the patients with CAD under resting and anger states. Methods: A matched case-control study was applied in this study. Participants were matched by gender and age into a HRV-BF group and a control group. Those in the HRV-BF group received a weekly one-hour HRV-BF training for six weeks, while those in the control group received usual medical care. During pretest and posttest, participants in both groups received a five-minute electrocardiogram measurement respectively at baseline, neutral description, neutral recovery, anger description, and anger recovery, and incidence rates of PVC were calculated. Results: In pretest, HRV-BF and control groups showed no significant difference in incidence rate of PVC at baseline, anger description, and anger recovery. In posttest, significant interaction was observed between the two groups in PVC incidence rate at baseline, anger description, and anger recovery. The Bonferroni post hoc comparison found no significant difference in incidence of PVC at baseline, anger description, and anger recovery for the HRV-BF group. However, the PVC incidence rate was higher at anger description than at anger recovery for the control group. Moreover, the PVC incidence rate at anger description appeared to be significantly lower in posttest than in pretest for the HRV-BF group, while there was no significant difference for the control group. Conclusion: HRV-BF can reduce the incidence of PVC in patients with CAD by increasing baroreflex homeostasis, cardiac vagal never activity, and cardiac autonomic nervous system activity. This invasive psychological intervention can be applied to assist medical care in the future.