射频消融局部去交感神经对心肌梗死犬心室不应期及心律失常易感性的影响(英文)  

Effect of local radiofrequency denervation on ventricular effective refractory period and ventricular arrhythmia susceptibility after acute myocardial infarction

作　　者：刘鹏[1] 王昊[1] 黄颖[1] 廖德宁[1] 

机构地区：[1]第二军医大学长征医院心内科,上海200003

出　　处：《第二军医大学学报》2013年第3期300-305,共6页Academic Journal of Second Military Medical University

基　　金：Supported by National Natural Science Foundation of China(81270244);Innovation Foundation of Second Military Medical University(ZD2012001)

摘　　要：目的探讨一种新的利用射频消融进行局部去交感神经的方法,并观察其对心脏电生理及程控心律失常诱发的影响。方法 18只杂种犬结扎冠状动脉第一对角支建立心肌梗死模型,之后沿冠状动脉左前降支均匀地自上而下行6个点射频放电消融(每点8W,2min)。所有实验动物均在心肌梗死后局部去神经前及去神经后通过S1S2程控刺激测定左心室表面6个部位的有效不应期(心梗上区域、心梗区域及心梗下区域各2个部位),并行短阵刺激诱发室性心律失常,记录诱发的心律失常数目。结果沿冠状动脉消融后,左心室各部位有效不应期显著延长[(191.3±24.9)ms vs(209.0±27.2)ms,P<0.05]。缺血区域有效不应期延长的时间[(11.3±8.8)ms]较缺血区域以上[(23.2±10.2)ms]及缺血区域以下[(18.7±11.5)ms]短(P<0.05)。消融前11只能诱发室性心律失常的犬中,消融后有8只未能再诱发心律失常,3只仍能诱发心律失常;心律失常的诱发率由61.1%(11/18)下降到16.7%(3/18;P=0.007)。结论本研究建立的方法可能是减少急性心肌梗死行经皮冠状动脉造影患者心律失常发生的一个可行方法。Objective To introduce a new method of local denervation by ablation and to observe its effect on ventricular effective refractory periods and ventricular arrhythmia susceptibility after acute myocardial infarction. Methods Eighteen mongrel dogs were used to make myocardial infarction model by ligation of the Is＇ diagonal artery. Then local denervation was achieved by using six radiofrequency ablations （each at 8 W for 2 rain） along the left anterior descending artery. Effective refractory periods were tested at six sites on the left ventricular epicardium （above, in and below the infarction areas, 2 sites each area） before and after local denervation by $1S2 stimulation. Ventricular arrhythmia was also induced after myocardial infarction and after denervation by burst pacing, and the number of arrhythmia episodes was recorded. Results The effective refractory periods were significantly prolonged after ablation （[191.3± 24.9] ms vs [209. 0±27. 2] ms, P%0.05）. And the prolongation of effective refractory periods in infarcted area （[11.3±8.8] ms） was significantly shorter than those in the other 2 areas （[23.2±10.2] ms and [18.7±11.5] ms）. After ablation, 8 of the 11 susceptible dogs were free of induced ventricular arrhythmia, while 3 of them were still inducible by burst pacing. The induced ventricular arrhythmia rate was reduced from 61.1% （11/18） to 16.7 %（3/18） （P=0. 007）. Conclusion The method in this study is promising for preventing ventricular arrhythmia in patients with acute myocardial infarction receiving pereutaneous coronary intervention.

关 键 词：交感神经 去神经支配 射频消融术 有效不应期 室性心律失常 

分 类 号：R331.38[医药卫生—人体生理学]