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|本期目录/Table of Contents|

射频消融术后心脏自主神经的变化对房颤早期复发的影响

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2013年第3期
页码:
337-340
栏目:
临床研究
出版日期:
2013-06-25

文章信息/Info

Title:
Influence of autonomic nerve system on early recurrence of atrial fibrillation after radiofrequency ablation of paroxysmal atrial fibrillation
作者:
孙亚娟1; 2; 石亚君1; 王晋丽1; 赵月香3; 郭红阳1; 王玉堂3; 单兆亮1
(解放军总医院：1.心内科，3.南楼心血管一科，北京 100853；2.解放军305医院心脏病中心，北京 100017)
Author(s):
SUN Ya juan1; 2;  SHI Ya jun1;  WANG Jin li1;  ZHAO Yue xiang13;  GUO Hong yang1;  WANG Yu tang3;  SHAN Zhao liang1
(1.Department of Cardiology, 3.Department of Cardiology of South Tower, PLA General Hospital, Beijing 100853, China; 2.Cardiology Center, PLA 305 Hospital, Beijing 100017, China)
关键词:
心房颤动; 射频消融术; 心脏自主神经; 心率变异性; 复发
Keywords:
paroxysmal atrial fibrillation;  heart rate variability;  autonomic nerves system;  circumferential pulmonary vein ablation;  recurrence
分类号:
R541.6
DOI:
-
文献标识码:
A
摘要:
目的:通过心率变异性分析，探讨左房环肺静脉消融术对自主神经系统的影响及其与心房颤动(房颤)早期复发的关系。方法:阵发性房颤患者90例，均接受CARTO指导下左房环肺静脉电隔离射频消融术。在术前3 d及术后3 d进行12导联动态心电图(Holter)监测，根据术后随访结果将患者分为房颤复发组(n=38例)和无复发组(n=52例)。并记录两组的平均心率(MeanHR)，心率变异性(heart rate variability,HRV)分析，包括时域指标SDNN、SDANN、rMSSD、PNN50，频域指标W、LF、HF、LF/HF，进行比较。结果:90例患者均达到肺静脉电隔离。术后反应迷走神经及交感神经张力的指标均显著降低；在无复发组，反应迷走神经张力的HF降低更显著，LF/HF升高，其它HRV指标均显著降低；在复发组，MeanHR升高，反应交感神经张力的LF显著降低，LF/HF降低。结论:降低迷走神经张力，可能会抑制阵发性房颤患者左房环肺静脉消融术后的早期复发。
Abstract:
AIM:To investigate the relationship between autonomic nerve system (ANS) and early recurrence of atrial fibrillation (AF) after left atrium circumferential pulmonary vein ablation. METHODS: A total of 90 paroxysmal atrial fibrillation patients underwent circumferential pulmonary vein ablation using CARTO system. All patients underwent 24hour ambulatory Holter monitoring and heart rate variability (HRV) analysis 3 days before and after the ablation, respectively. Patients were divided into recurrence group (n=38) and nonrecurrence group (n=52) based on the postoperative Holter results, symptoms and ECG. The average heart rate (MeanHR), time domain indexes (such as SDNN, SDANN, rMSSD, PNN50) and frequency domain index (such as W, LF, HF, LF/HF) of the two groups were compared. RESULTS: Electrical isolation of the pulmonary veins was achieved in all the 90 patients. The parameters indicated the activities of parasympathetic and sympathetic decreased significantly after ablation in both groups. In nonrecurrence group, indictors of parasympathetic tone were significantly lower, whereas those of sympathetic tone were higher in recurrence group. CONCLUSIONS: Vagal denervation may inhibit early recurrence of atrial fibrillation after left atrium circumferential pulmonary vein ablation in paroxysmal AF patients.

参考文献/References

[1]Kuo JY,Chen SA.Is vagal denervation a good alternative or just adjunctive to pulmonary vein isolation in catheter ablation of atrial fibrillation?[J].J Am Coll Cardiol,2007,49(12):1349-1351.
[2]夏 阳,杨志健,张家友,等.射频消融犬心脏第三脂肪垫消弱Bezold Jarisch反射[J].中国心脏起搏与心电生理杂志,2009,23(5):433-436.
[3]Pokushalov E.The role of autonomic denervation during catheter ablation of atrial fibrillation[J].Curr Opin Cardiol,2008,23(1):55-59.
[4]杨玉辉，郑强荪,董建军,等.消融犬右肺静脉脂肪垫对心房及右上肺静脉电生理特性及房颤诱发的影响[J].心脏杂志,2006,18(1):28-30.
[5]Patterson E,Po S,Schedag BJ,et al.Triggered firing in pulmonary veins initiated by in vitro autonomic nerve stimulation[J].Heart Rhythm,2005,2(6):624-631.
[6]Chen J,Wasmund S,Hamdan M,et al.Back to the future:the role of the autonomic nervous system in atrial fibrillation[J].PACE,2006,29(4):413-421.
[7]Zhou J,Scherlag B,Ewards J,et al.Gradients of atrial refractoriness and inducibility of atrial fibrillation due to stimulation of ganglionated plexi[J].J Cardiovasc Electrophysiol,2007,18(1):83-90.
[8]Pappone C,Santinelli V,Manguso F,et al.Pulmonary vein denervation enhances long term benefit after circumferential ablation for paroxysmal atrial fibrillation[J].Circulation,2004,109(3):327-334.
[9]Tan AY,Li H,WachsmannHogiu S,et al.Autonomic innervation and segmental muscular disconnections at the human pulmonary veinatrial junction:implications for catheter ablation of atrial pulmonary vein junction[J].J Am Coll Cardiol,2006,48(1):132-143.
[10]刘 蔚,高 梅,王奖荣,等.刺激左右颈部迷走交感干对兔心房电生理特性的影响[J].心脏杂志,2010,22(2):176-182.
[11]Nakagawa H,Scherlag BJ,Aoyama H,et al.Catheter ablation of cardiac autonomic nerves for prevention of atrial fibrillation in a canine model[J].Heart Rhythm,2004,3(6):S10.
[12]Chevalier P,Tabib A,Meyronnet D,et al.Quantitative study of nerves of the human left atrium[J].Heart Rhythm,2005,2(5):518-522.
[13]Tan AY,Li H,WachsmannHogiu S,et al.Autonomic innervation and segmental muscular disconnections at the human pulmonary veinatrial junction: implications for catheter ablation of atrial pulmonary vein junction[J].J Am Coll Cardiol,2006,48(1):132-143.
[14]马 丽,侯月梅.心脏自主神经与心房颤动[J].国际心血管病杂志, 2007, 3(34):94-97.

备注/Memo

备注/Memo:
收稿日期：2013-02-06.
基金项目：国家自然科学基金项目资助（81270308）
通讯作者：单兆亮，主任医师，主要从事心脏电生理研究 Email：shanzl301@sina.com
作者简介：孙亚娟，硕士生 Email：srcs9898@sina.com
更新日期/Last Update: 2013-07-16