序列消融犬窦房结脂肪垫和房室结脂肪垫对迷走神经介导心房颤动诱发的影响  

Efficacy of sequential ablation of sinus atrial node fat pad and atrialventricular node fat pad on inducibility of atrial fibrillation evoked by vagus trunk stimulation

作　　者：周祁娜[1] 张小琴[2] 张玲[1] 杨尚磊[1] 陈华[1] 马艳红[1] 宋伟[1] 侯月梅[1] 

机构地区：[1]新疆医科大学第一附属医院心律失常科,乌鲁木齐830054 [2]新疆医科大学第五附属医院心功能科

出　　处：《中华心血管病杂志》2011年第12期1088-1093,共6页Chinese Journal of Cardiology

基　　金：基金项目：国家自然科学基金项目（30960132）

摘　　要：目的 研究旨在探索序列消融窭房结脂肪垫（sinus atrial node fat pad,SANFP）和房室结脂肪垫（atrialventricular node fat pad,AVNFP）对迷走神经介导的心房颤动（房颤）诱发的影响.方法 18只健康成年家犬分为二组,每组9只.A组优先消融SANFP,再联合消融SANFP＋ AVNFP;B组优先消融AVNFP,再联合消融SANFP＋ AVNFP.高频电刺激左、右侧迷走神经干制作迷走神经介导的房颤模型,测定消融前、后的房颤诱发率及心房和肺静脉不同部位有效不应期（effective refractory period,ERP）.结果 （1）迷走神经干刺激可显著增加房颤的诱发率,且右侧迷走神经干刺激下的房颤诱发率高于左侧迷走神经干[（60.0±0.0）％比（18.4±22.1）％].（2）优先消融SANFP可显著降低左侧迷走神经干或右侧迷走神经干刺激下房颤的诱发率（分别降低了67.0％和72.0％）,联合消融SANFP＋ AVNFP可进一步降低2V电压的左侧迷走神经干或右侧迷走神经干刺激下房颤的诱发率（分别较消融前降低了100％和95.5％）.而优先消融AVNFP也可显著降低2V电压的左侧迷走神经干或右侧迷走神经干刺激下房颤的诱发率（分别降低了95.7％和96.3％）,但联合消融SANFP＋ AVNFP并不进一步显著降低左侧迷走神经干或右侧迷走神经干刺激下的房颤诱发率（分别较消融前降低了98.0％和100％）.（3）优先消融SANFP或AVNFP均可显著抑制迷走神经干刺激引起的右房、左房及右上肺静脉部位的ERP缩短效应.与单独消融SANFP相比,联合消融SANFP＋AVNFP可进一步抑制迷走神经干刺激引起右房ERP的缩短效应,而联合消融AVNFP＋ SANFP对迷 走神经干刺激引起左、右心房及肺静脉ERP的缩短效应的抑制作用与单独消融AVNFP比较差异无统计学意义.结论 心外膜脂肪垫消融可改变迷走神经干刺激对房颤诱发及心房肌、肺静脉ERP的影响,其中AVNFP是迷走神经干支配心房的汇聚点和主控区Objective To explore the efficacy of sequential ablation of epicardial fat pad on inducibility of atrial fibrillation （AF） evoked by stimulating vagus trunk.Methods Eighteen adult mongrel dogs were randomly divided into 2 groups （n =9 each）：Group A underwent pre-ablation of sinus-atrial node fad pad （SANFP） and subsequent ablation of atria-ventricular node fad pad （AVNFP）.Group B underwent pre-ablation of AVNFP and subsequent ablation of SANFP.AF was induced by high-frequency electrical stimulation of bilateral vagus trunks.The AF inducibility and effective refractory period （ERP） changes during vagus trunk stimulation were examined before and after ablation in atria and pulmonary veins.Results （1） AF could be induced by vagus trunk stimulation and the incidence was higher during right vagus trunk （RVG） stimulation than left vagus trunk （LVG） stimulation [ （60.0 ± 0.0） % vs （ 18.4 ± 22.1 ） % ].（2）SANFP ablation significantly attenuated AF inducibility with LVG stimulation and RVG stimulation at 2 V （decreased 67.0% and 72.0%,respectively）.Subsequent AVNFP ablation after SANFP ablation further reduced AF inducibility with LVG and RVG stimulation at 2 V （decreased 100.0% and 95.5%,respectively）.（3）AVNFP ablation （decreased 95.7% and 96.3%,respectively） and subsequent SANFP ablation after AVNFP ablation （ decreased 98.0% and 100.0%,respectively） significantly attenuated AF inducibility with LVG stimulation and RVG stimulation at 2V.（4） Vagal stimulation induced ERP shortening was significantly attenuated by isolated SANFP ablation or AVNFP.Subsequent AVNFP ablation after SANFP induced significant ERP shortening in right atrial site compared with isolated SANFP ablation.However,changes of ERP shortening were similar between AVNFP ablation and subsequent SANFP ablation after AVNFP ablation.Conclusions Epicardial fat pad ablation reduced the AF inducibility and prolonged ERP of atria and pulmonary veins during vagus trunk stimulation.AVNFP,as the �

关 键 词：心房颤动 导管消融术 迷走神经 脂肪组织 

分 类 号：R541.75[医药卫生—心血管疾病]