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|本期目录/Table of Contents|

冷冻球囊消融治疗心房颤动术中迷走神经反射对复发的影响

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2018年第5期
页码:
524-527
栏目:
临床研究
出版日期:
2018-06-25

文章信息/Info

Title:
Influence of vagal reflex after cryoballoon ablation on the recurrence of atrial fibrillation
作者:
丁 建; 王祖禄; 杨桂棠; 梁 明; 孙鸣宇; 丁明英; 张 萍; 韩雅玲
（沈阳军区总医院心内科，辽宁 沈阳 110016）
Author(s):
DING Jian;  WANG Zu-lu;  YANG Gui-tang;  LIANG Ming;  SUN Ming-yu;  DING Ming-ying;  ZHANG Ping;  HAN Ya-ling
(Department of Cardiology, Shenyang General Hospital, Shenyang Military Area Command, Shenyang 110016, Liaoning, China)
关键词:
心房颤动; 冷冻球囊消融; 迷走神经反射; 复发
Keywords:
atrial fibrillation;  cryoballoon ablation;  vagal reflex;  recurrence
分类号:
R541.7
DOI:
-
文献标识码:
A
摘要:
目的 研究冷冻球囊消融治疗心房颤动（房颤）术中出现迷走神经反射对手术成功率的影响。方法 分析行冷冻球囊消融的阵发性/持续性房颤患者103例，根据术中是否发生迷走神经反射分为两组：迷走神经反射组（n=40）和非迷走神经反射组（n=63）。比较两组患者的基线资料，术中参数及即刻成功率。术后随访至少12个月，观察房颤的复发率。结果 两组在并发高血压病、糖尿病和脑梗死以及左房内径等方面均无统计学差异。两组术中应用23 mm小球囊的比例、手术时间、X线曝光时间、曝光量也均无显著差异。术中出现较长时间严重迷走神经反射2例，经心室起搏、静注阿托品后恢复。术后随访12~21（13.6±2.3）个月，迷走反射组复发14例（35%），非迷走神经反射复发20例（32%），两组间无显著统计学差异。结论 冷冻球囊隔离肺静脉治疗房颤术中出现迷走神经反射不影响房颤术后复发。
Abstract:
AIM To investigate the effect of vagal reflexes after cryoballoon ablation on the recurrence of atrial fibrillation (AF). METHODS One hundred and three consecutive patients with paroxysmal/persistent AF underwent cryoballoon ablation. They were divided into two groups based on whether vagal reflexes occurred after cryoballoon ablation. The baseline characteristics, ablation parameters, and success rate were compared between the two groups. The primary endpoint was the recurrence rate of atrial fibrillation after 12-month post ablation. RESULTS There were a total of 40 patients in the vagal reflex group and 63 patients in the control group. There were no significant differences in hypertension, diabetes mellitus, cerebral infarction, or left atrial diameter between the two groups. There were no significant differences in the application of a 23 mm balloon, operation times, or X-ray exposures between the two groups. There were 2 patients that had longer time of severe vagal reflex, which recovered after ventricular pacing and injection of atropine. AF recurrence occurred in 14 patients (35%) in the vagal reflex group and in 20 (32%) in the control group. The recurrence between the two groups had no significant difference. CONCLUSION Vagal reflex during cryoballoon ablation of AF has no significant influence on postablation recurrence of AF.

参考文献/References

[1]Scherlag BJ,YamanashiW,Patel U,et al.Autonomically induced conversion of pulmonary vein focal firing into atrial fibrillation[J].J Am Coll Cardiol,2005,45(11):1878-1886.

[2]Oh S,Zhang Y,Bibevski S,et al.Vagal denervation and atrial fibrillation inducibility:epicardial fat pad ablation does not have long-term effects[J].Heart Rhythm,2006,3(6):701-708.

[3]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.

[4]Pokushalov E,Romanov A,Artyomenko S,et al.Ganglionated plexi ablation directed by high-frequency stimulation and complex fractionated atrial electrograms for paroxysmal atrial fibrillation[J].Pacing Clin Electrophysiol,2012,35(7):776-784.

[5]Calo L,Rebecchi M,Sciarra L,et al.Catheter ablation of right atrial ganglionated plexi in patients with vagal paroxysmal atrial fibrillation[J].Circ Arrhythm Electrophysiol,2012,5(1):22-31.

[6]Zhang Y,Wang Z,Wang W,et al.Efficacy of cardiac autonomic denervation for atrial fibrillation:a meta-analysis[J].J Cardiovasc Electrophysiol,2012,23(6):592-600.

[7]Camm AJ,Kirchhof P,Lip GY,et al.Guidelines for the management of atrial fibrillation:the Task Force for the Management of Atrial Fibrillation of the European Society of Cardiology(ESC)[J].Europace,2010,12(10):1360-1420.

[8]Sharifov OF,Fedorov VV,Beloshapko GG,et al.Roles of adrenergic and cholinergic stimulation in spontaneous atrial fibrillation in dogs[J].J Am Coll Cardiol,2004,43(3):483-490.

[9]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.

[10]Patterson E,PoSS,Scherlag BJ,et al.Triggered firing in pulmonary veins initiated by in vitro autonomic nerve stimulation[J].Heart Rhythm,2005,2(6):624-631.

[11]Patterson E,Lazzara R,Szabo B,et al.Sodium-calciumexchange initiated by the Ca2+ transient:an arrhythmia trigger within pulmonary veins[J].J Am Coll Cardiol,2006,47(6):1196-1206.

[12]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.

[13]Scanavacca M,Pisani CF,Hachul D,et al.Selective atrial vagal denervation guided by evoked vagal reflex to treat patients with paroxysmal atrial fibrillation[J].Circulation,2006,114(9):876-885.

[14]杨桂棠,王祖禄,梁 明,等.冷冻球囊导管消融治疗心房颤动围术期并发症的分析[J].中华心律失常学杂志,2015,9(3):179-183.

[15]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.

[16]唐 闵,姚 焰,张劲林,等.肺静脉口周消融造成去迷走效应对心房颤动消融效果的影响[J].中华心律失常学杂志,2005,9(2):110-114.

[17]刘 颖, 刘赛哲,辛 倩, 等.心外膜脂肪体积与心房颤动发病及空白期复发的相关性研究[J].中华老年心脑血管病杂志,2016,18(4):375-379.

[18]Nademanee K,McKenzie J,Kosar E,et al.A new approach for catheter ablation of atrial fibrillation:mapping of the electrophysiologic substrate[J].Am Coll Cardiol,2004,43(11):2044-2053.

备注/Memo

备注/Memo:
收稿日期：2017-08-28.通讯作者：王祖禄，主任医师，主要从事心律失常诊治与研究 Email：wangzl@medmail.com.cn 作者简介：丁建，主治医师，硕士 Email：dingjian-2001@163.com
更新日期/Last Update: 1900-01-01