肾去交感神经对心房神经节刺激诱发心房颤动的影响  

Effect of renal sympathetic denervation on the inducibility of atrial fibrillation by anterior right gangli- onic plexi stimulation

作　　者：于胜波[1] 代子玄[1] 邹明辉[1] 王徐乐[1] 肖金平[1] 赵庆彦[1] 黄从新[1] 

机构地区：[1]武汉大学人民医院心内科,430060

出　　处：《中华心律失常学杂志》2013年第1期60-62,共3页Chinese Journal of Cardiac Arrhythmias

基　　金：国家自然科学基金（81070144）

摘　　要：目的探讨经导管消融肾交感神经后对心房右前神经节（ARGP）刺激诱发心房颤动（房颤）的影响。方法13只犬随机分为对照组（n=7）和消融组（rt=6）。对照组犬于右侧第4肋间开胸，采用不同电压高频刺激（20Hz，0．1ms）ARGP，观察心率减慢和房颤诱发情况；消融组犬先监测心房有效不应期（AERP），后行双侧经皮介入肾动脉消融，喂养6周后ARGP刺激同对照组。消融组犬在肾动脉消融前及后6周取静脉血检测血管紧张素Ⅱ（AngII）及醛固酮水平。结果消融组AERP在消融前及后6周差异无统计学意义[（134．4±19．2）ms对（142．0±21．5）ms，P〉0．05]。与对照组相比，消融组犬ARGP刺激引起心率减慢50％所需电压[（3．5±1．6）V对（1．6±0．3）V，P=0．03]和诱发房颤的最低电压[（5．1±1．0）V对（2．1±0．7）V，P=0．03]明显升高。消融组犬消融6周后血清Ang1／[（142．8±31．7）pg／rnl对（91．7±23．8）pg／ml，P=0．01]和醛固酮水平[（272．2±37．4）pg／ml对（156．3±17．6）pg／ml，P〈0．01]明显降低。结论。肾去交感神经可抑制ARGP刺激对房颤的诱发，其机制可能与肾去交感神经后肾素一血管紧张素一醛固酮系统活性降低有关。Objective To investigate the effect of renal sympathetic denervation on inducibility of atrial fibrillation（AF） by anterior right ganglionic plexi （ARGP）stimulation. Methods Thirteen dogs were used for the study as follows ：control group（ n = 7 ） and renal artery ablation （ RAA ） group （ n = 6 ）. In control group, after right thoracotomy, high-frequency electrical stimulation（ 20 Hz ,0. 1 ms duration）was applied to the ARGP for 1 minute by incremental voltages up to the voltage that induced AF. In RAA group, after atrial effective refractory period （AERP） measured ,each renal artery was ablated and dogs were raised for 6 weeks. The procedure of ARGP stim- ulation was same as in the control group. Blood was collected before and after ablation 6 weeks to measure the lev- els ofangiotensin 11（ Ang 11）and aldosterone（ALD） in RAA dogs. Results AERP had no significant change be- fore and after renal artery ablation 6 weeks [ （ 134. 4 ± 19. 2 ） ms vs （ 142. 0 ± 21.5 ） ms, P〉 0. 05 ]. Compared with that in control group ,dogs had higher voltage in the sinus rate slowing response induced by ARGP stimulation in RAA group[ （3.5±1.6）V vs（ 1.6±0. 3）V,P=0. 03]. Furthermore,the lowest voltage that induce AF was higher in RAA group than that in control group[ （5.1±1.0）V vs（2. 1±0. 7）V,P=0. 031. The plasma Ang II and aldo- sterone concentration showed a greatly decreasing after RAA 6 weeks in RAA group[ Ang 11： （ 142. 8±31.7）pg/ml vs （ 91.7 ±23. 8 ） pg/ml ,P = 0. 01 ; Aldostcrone ： （272. 2±37.4） pg/ml vs （ 156. 3 ± 17. 6 ） pg/ml, P〈0. 01 ]. Conclu- sions Renal sympathetic denervation inhibited the inducibility of AF during ARGP stimulation. This effect might have relationship with decreased activity of renin-angiotensin-aldosterone system（RAAS）.

关 键 词：心房颤动 肾交感神经 消融 肾素-血管紧张素-醛固酮系统 

分 类 号：R541.75[医药卫生—心血管疾病]