心脏脂肪垫在肺静脉引发房颤中的作用  

Study the eEffect of "Sino-Atrial" Fat Pad at the veno-atrial junction on converting focal pulmonary vein firing into arial fibrillation.

作　　者：侯月梅[1] 康慧[2] Benjaming J Scherlag 

机构地区：[1]新疆医科大学第一临床学院心血管病专科医院,830054 [2]新疆石油管理局明圆石油医院保健科,830054 [3]美国俄克拉荷马州立大学医学科学研究中心,830054

出　　处：《临床心电学杂志》2007年第2期123-126,共4页Journal of Clinical Electrocardiology

基　　金：国家自然科学基金(项目编号:30560050)

摘　　要：目的探讨窦房结-心房脂肪垫(SAFP)在右上肺静脉灶性放电引发阵发性房颤(PAF)中的作用。方法12条新疆家养犬,苯巴比妥钠麻醉,经右侧开胸暴露右侧肺静脉。将1根8极标测电极导管固定在右上肺静脉,给予S1S1600bpm起搏刺激,另将1根8极(1.5×1.5cm)电极板固定在心外膜窦房结-心房脂肪垫上。术中监测II和aVR导联、血压和体温。以1～4V电压、1000bpm频率刺激窦房结-心房脂肪垫30～60s。结果12条家养犬在给予S1S11000ppm窦房结-心房脂肪垫刺激,随着电压从1增加到4V,心率从142±20bpm减少到75±30bpm(p<0.05),同时出现房性早搏、房性心动过速(房速)和房颤,同时予以右上肺静脉S1S1600ppm刺激,诱发房颤的房性早搏数随着刺激电压1～4V的增加从7个减少到2个,并以S1S1300ms,S1S2稍长于右上肺静脉不应期的早搏右上肺静脉刺激。S1S1600ppm刺激下房颤诱发率从基础状态的49.86%提高到70.59%,S1S2早搏刺激下从3.78%提高到16.6%(p<0.05)。7条狗在4%利多卡因4ml注射到窦房结-心房脂肪垫局部阻滞神经后,6条狗在同样右上肺静脉刺激诱发房颤电压的条件下不能诱发房颤,其中3条狗在电压增加大于9V时诱发房颤。房颤诱发的有效刺激部位在窦房结-心房脂肪垫2～3mm的范围内。结论有效部位窦房结-心房脂肪垫刺激,能够诱发慢频率依赖性阵发性房颤,刺激窦房结-心房脂肪垫增加右上肺静脉阵发性房颤的诱发率,局部神经阻滞降低或消除阵发性房颤的诱发.提示:增强窦房结-心房脂肪垫的自发神经放电,可能是临床右上肺静脉灶性放电转变成房颤的基础,消融窦房结-心房脂肪垫可能预防阵发性房颤的诱发。Objective In 14 dogs, anesthetized with Na-pentobarbital,the right superior pulmonary vein （RSPV） was exposed via a right thoractomy; an octapolar electrode catheter was sutured against the RPSV for pacing site. Another octapolar electrode patch fixed to the SAFP containing a ganglionated plexis（GP）at the junction of RSPV. ECG leads Ⅱ and aVR, blood pressure and temperature were continuously monitored. SAFP be stimulated with 1000ppm and voltage 1-4V for 30-50s. Results The stimulation caused a progressive reduction in heart rate from 142±20 bpm to 75±30bpm（p〈0.05）and the atria premature, atria tachycardia and atria fibrillation compared with the control group;Pacing RSPV at S1S1 330ms,8：1 and S1S2 at coupling interval just longer than RSPV refractoriness, while stimulating the SAFP, we induced AF.7dogs.（anesthetized with lidocaine 2%4ml） at SAFP,6 of 7dogs,atrial fibrillation could not be induced with same voltage, and 3 of 7 dogs,atrial fibrillation were induced with voltage more than 9V.The spots of vulnerability for AF was focal within 2-3mm of SAFP and the window for inducing AF was 77±24-13±23bpm . Conclusion Enhanced spontaneous neural activity at SAFP ,Clinically ,may serve as a substrate for focal PV firing （triggers） into PAF. Ablation of SAFP may prevent AF induction.

关 键 词：窦房结-心房脂肪垫 右上肺静脉 阵发性心房颤动 

分 类 号：R541.75[医药卫生—心血管疾病]