左心房去神经化导管消融治疗对血管迷走性晕厥患者心脏自主神经功能的影响  

Effects of Left Atrial Vagal Denervation by Catheter Ablation on Autonomic Function of Patients With Vasovagal Syncope

作　　者：郑黎晖[1] 孙巍 刘尚雨 梁二鹏 杜忠鹏[1] 胡锋 吴灵敏[1] 姚焰[1] ZHENG Li-hui;SUN Wei;LIU Shang-yu;LIANG Er-peng;DU Zhong-peng;HU Feng;WU Ling-min;YAO Yan(Arrhythmia Center,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing(100037),China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院心律失常中心,北京市100037 [2]北京清华长庚医院清华大学医学中心

出　　处：《中国循环杂志》2018年第12期1203-1207,共5页Chinese Circulation Journal

基　　金：国家重点研发计划资助(2017YFC1307800);首都临床特色应用研究(Z121107001012014)

摘　　要：目的:探讨左心房去神经化导管消融治疗对血管迷走性晕厥(VVS)患者心脏自主神经功能的影响。方法:连续入选我科症状严重、倾斜试验阳性并接受左心房自主神经节(GP)消融治疗的VVS患者42例。术前及术后1年内定期复查动态心电图,分析患者的心率减速力(DC)及心率变异性变化。根据1年随访期间患者有无再发晕厥,分为未复发晕厥组和复发晕厥组。并以9例症状严重、倾斜试验阳性但未行导管消融治疗的VVS患者作为对照组。结果:消融术后1年随访期间,6例(14.3%)患者仍有晕厥发作。复发晕厥组、未复发晕厥组及对照组患者的基线DC值差异无统计学意义[(7.8±2.7)ms vs (9.8±3.7)ms vs(8.2±3.5) ms,P>0.05]。未复发晕厥组患者在术后1天的DC值迅速降低(P<0.05),在术后1、3、6及12个月随访期间DC值呈现缓慢增加趋势(P>0.05),但始终低于基线DC值(P<0.05);平均最慢心率和窦性QRS波的总体标准差及其差值的均方根在术后1天较之于术前(基线)均有所变化(P均<0.05),这一效果也持续至术后12个月(P均<0.05)。随访期间,复发晕厥组和对照组患者DC值和心率变异性与基线相比差异均无统计学意义(P均>0.05)。结论:左心房去神经化导管消融治疗能通过降低迷走神经张力预防血管迷走性晕厥的复发。Objectives: The feasibility and safety of left atrial(LA) vagal denervation by catheter ablation to treat highly symptomatic patients with vasovagal syncope(VVS) have been validated. However, their effects on cardiac autonomic function and relationships to the recurrent syncope remain unclear in patients with VVS. Methods: Forty-two consecutive highly symptomatic VVS patients([41±14] yrs, 18 males) with a positive response to head-up tilt test(HUT) undergoing LA ganglionated plexi catheter ablation were included in this study. Holter recordings were made at baseline and at regular intervals for up to 1 year after ablation. Autonomic function was evaluated by deceleration capacity(DC) and heart rate variability. Nine highly symptomatic HUT positive VVS patients, who did not receive ablation therapy served as controls.Results: During one-year follow-up period, 6 patients(14.3%) experienced recurrent syncope. DC was similar between no-recurrence group and recurrence group and controls([7.8±2.7] ms vs [9.8±3.7] ms vs [8.2±3.5] ms, P>0.05). In the patients without recurrent syncope, DC significantly decreased at 1 day after ablation, and increased slowly during the 1, 3, 6 and 12 months after ablation, while remained lower than the baseline DC(P<0.05). In both the recurrent syncope group and control group, the DC value during the follow-up period was similar as the baseline level. Conclusions: LA denervation may induce a decrease of vagal nerve tone and, which may effectively prevent recurrent syncope in highly symptomatic VVS patients.

关 键 词：血管迷走性晕厥 导管消融 自主神经功能 心率减速力 

分 类 号：R54[医药卫生—心血管疾病]