右侧神经丛消融对阵发心房颤动伴窦性心动过缓心率的影响

摘要

Objective:Previous studies showed that catheter ablation of atrial fibrillation (AF) results in vagal denervation with an increase in average heart rate (HR) and a reduced overall HR variability (HRV) at follow-up. We analyzed right atrial ablation-induced changes in HR after percutaneous circumferential pulmonary vein isolation (CPVI). Methods:A total of 12 patients (9 men,60. 58 ±9. 25 years) undergoing CARTO and computed tomography-guided CPVI for symptomatic AF were studied. Circumferential pulmonary vein isolation was performed under local anesthesia by widely encircling the left and right pulmonary veins. The endpoint for CPVI in each patient was the elimination of PV potentials during sinus rhythm. Then radiofrequency ablation at right atrial anatomic sites, where the main clusters of ganglionated plexi have been identified in the right atrium, was performed. Results:Compared with sinus rate after CPVI, a significant increase in sinus rate ongoing right atrial ganglionated plexi ablation. Significant difference was noted in the mean heart rate after preablation when compared with the baseline value (56. 67 ±4. 87) bpm at baseline, (68. 92 ±6. 20, 65. 75 ±4. 09) bpm at first week, and 6months after ablation). The HRV parameters of SDNN were significantly decreased after ablation (132. 83 ± 16. 70) ms at baseline, (87. 67 ±19. 21) ms, (109. 75 ±18. 65) at first week, and 6months after ablation. Conclusion: Although the parasympathetic modulation was significantly attenuated after the PVI procedure, the heart rate still increases after right atrial ganglionated plexi ablation.%目的:探讨环肺静脉消融的基础上,进一步进行右侧神经丛消融以观察消融对心率的影响.方法:12例心动过缓伴心房颤动的患者,其中男性9例,女性3例,平均年龄(60.58±9.25)岁,在完成环肺静脉隔离的基础上,进行解剖指导下右侧神经丛的消融.结果:12例均完成四个肺静脉隔离及上腔静脉去神经消融,消融上腔静脉过程中,心率由(72.92±5.30) 次/min增加到(84.58±5.63)次/min,术后平均随访(18±8)个月,心房颤动成功率50％.心率由术前(56.67±4.87)次/min,增加到术后1w(68.92±6.20)次/min,术后6个月(65.75±4.09)次/min.心率变异性(SD NN)由术前(132.83±16.7)ms减少为术后1w(87.67±19.21 )ms,术后6个月(109.75±18.65)ms.结论:在环肺静脉消融的基础上,进行解剖指导下的上腔静脉消融可以进一步提高心率,达到去迷走神经支配的目的.