经心外膜聚焦超声消融治疗犬心房颤动的实验研究  

Epicardial Focused Ultrasound Ablation for Atrial Fibrillation in Dogs

作　　者：张波[1] 雷森[1] 殷跃辉[1] 凌智瑜[1] 李崇雁[2] 杜永红[2] 王志刚[2] 

机构地区：[1]重庆医科大学附属第二院心内科,重庆市400010 [2]重庆医科大学超声工程研究所,重庆市400010

出　　处：《中国超声医学杂志》2008年第7期584-587,共4页Chinese Journal of Ultrasound in Medicine

摘　　要：目的探讨聚焦超声经心外膜的环肺静脉消融(CPVa)和左房盒式消融(BOXa)对房颤的影响。方法成年杂种犬20只,随机分为两组,建立肺静脉起源的阵发性房颤模型后,直视下分别行环肺静脉消融和左房盒式消融。消融前、后记录左房有效不应期(LA-ERP)、计算房颤诱发率、记录房颤持续时间,术毕行组织学检查。结果所有犬均能诱发出肺静脉起源的阵发性房颤,房颤终止后的LA-ERP较基线水平显著缩短[CPVa组:(140±10)msvs(102±10)ms,P<0.01;BOXa组:(139±11)msvs(105±8)ms,P<0.01],但消融前后的LA-ERP并无显著性差异[CPVa组:(102±10)msvs(110±8)ms,P=0.070;BOXa组:(106±7)msvs(111±7)ms,P=0.225]。消融后两组的房颤诱发率均较消融前显著降低[(98±4)%vs(28±10)%,P<0.01;(97±4)%vs(14±7)%,P<0.01],房颤持续时间均显著缩短[(233±40)svs(70±29)s,P<0.01;(240±41)svs(34±22)s,P<0.01];部分犬可见肺静脉-心房双向电传导阻滞;两组间消融前房颤诱发率、房颤持续时间无统计学差别,消融后BOXa组房颤诱发率和房颤持续时间低于/短于CPVa组(P<0.05)。消融后焦域内的组织呈凝固性坏死。结论经心外膜聚焦超声环肺静脉消融可显著降低房颤诱发率和缩短房颤持续时间,而左房盒式消融则可进一步提高成功率。Objective To explore the feasibility of focused ultrasound ablation （FUA） on paroxysmal atrial fibrillation （PAF）, and to compare the efficacy of circumferential pulmonary veins ablation （CPVa） and Box ablation of left atrium （BOXa） . Methods Twenty mongrel dogs were studied. CPVa or BOXa wrer performed with the focused ultrasound catheter after the PAF models were established, and the epicardial electrograms were recorded with the quadripolar electrode catheter placed at pulmonary veins （PV） and left auricular appendage （LAA） . Left atrial effective refractory period （LA-ERP） was measured. The inducibility and lasting time of atrial fibrillation （AF） were also assessed. The histology of lesions was studied after the two procedures. Results PAF arising from the PVs was induced in all the dogs. After the models were successfully established, the LA-ERP was significantly shorter than before, but there was no significant change in both groups. Bi-directional conduction blocks were achieved in some of the two groups after FUA. The inducible rates of AF in the two groups were： 98±4% vs 28± 10% in CPVa group, P〈0.01, 97±4% vs 14±7% in BOXa group, P〈0.01） both of which were decreased significantly, and the lasting times of AF were 233±40s vs 70±29s, in CPVa, P〈0.01; 240±41s vs 34±22s, in BOXa, P〈0.01, which were also shortened notably after FUA. Inducibility （P= 0. 021） and lasting time （P= 0. 048） of AF were significantly lower in group CPVa than those of BOXa after FUA. Histological evaluation of the lesions showed coagulated necrosis after FUA. Conclusions AF can be eliminated feasibly and efficiently by CPV ablation and Box ablation, and the latter was more effective.

关 键 词：心房颤动 聚焦超声消融 肺静脉 左房 

分 类 号：R541.75[医药卫生—心血管疾病] R454.3[医药卫生—内科学]