选择性消融窦房与房室结周神经治疗缓慢性心律失常的心率波动频谱分析研究

摘要

目的 探讨动态心电图心率波动频谱分析对选择性消融窦房结与房室结周围神经治疗缓慢性心律失常患者的作用.方法 选择症状严重、拟行起搏器治疗的阵发性心动过缓患者35例,术前行动态心电图检查并进行心率波动频谱分析.对于症状及频谱分析支持心动过缓为迷走神经张力增高所致的患者,在X线与64排螺旋CT心脏解剖影像指导下,标测实性心律下的心房激动顺序,围绕并避开心房最早激动点和His束区域,记录心内电图神经组织电位,温控射频消融,观察消融反应,随访治疗效果.结果 成功的30例患者中,28例高频成分(HF)明显,低频成分(LF)存在；2例为LF缺失,HF明显.复发的5例患者中4例为LF缺失,HF明显；1例为HF明显,LF存在.术后动态心电图检查,成功的30例患者中17例HF明显降低,余无明显变化.复发的5例患者中1例HF明显降低,余无明显变化.电生理检查显示,消融后患者基础心率、SNRT、WP、AH间期都得到了明显改善(P＜0.01).结论 对于心率波动频谱分析支持心动过缓系由迷走神经张力增高所致的患者,选择性消融窦房结或房室结周围神经有较好治疗效果.%Objective To analyze of the heart rate fluctuation in selective ablation of sinoatrial and atrioventricular nodal peripheral nerve in treating patients with bradyarrhythmias. Methods Holter preoperative examination and spectral analysis of heart rate fluctuations were performed in selective patients with severe symptoms, scheduled for the treatment of paroxysmal bradycardia using pacemaker. For patients in whom the vagal bradycardia was suggested by the symptoms and spectrum analysis,ablation of sinoatrial and atrioventricular nodal peripheral nerve was performed under of the mapping atrial activation sequence during sinus rhythm combined with X-ray and 64-slice spiral CT imaging cardiac anatomy. The target sites were around but away from the first excited atrial point and His bundle region to record intracardiac electrogram potential of nerve tissue. Results The success of the 30 patients, 28 cases of high frequency components( HF) were significant, low frequency components(LF) were existent; 2 cases of deletions of LF,HF was significant. Recurrence in 5 patients, 4 patients were deletions of LF.HF was significant; 1 patient of HF was significant,LF was existent. Postoperative dynamic electrocardiogram examination,successful in 30 patients, 17 cases of HF were decreased: recurrence in 5 patients, 1 case of HF was decreased. Electrophysiological examination showed, after catheter ablation in patients, basal heart rate, SNRT, WP, AH interval were improved significantly( P < 0. 01). Conclusion For the heart rate fluctuation spectrum supports the heart beat bradycardia patients, selective ablation of sinoatrial and atrioventricular nodal peripheral nerve will have better effect in the treatment.