左心房心内膜去神经化射频消融治疗难治性血管迷走性晕厥的安全性和有效性研究  

Safety and Efficacy of Left Atrial Endocardial Vagal Denervation Catheter Ablation for Treating the Patients With Refractory Vasovagal Syncope

作　　者：孙巍[1] 郑黎晖[1] 姚焰[1] 乔宇[1] 侯炳波[1] 吴灵敏[1] 郭金锐[1] 张澍[1] 

机构地区：[1]北京协和医学院中国医学科学院国家心血管病中心阜外医院心律失常诊治中心,北京市100037

出　　处：《中国循环杂志》2016年第3期254-258,共5页Chinese Circulation Journal

基　　金：首都临床特色应用研究(Z121107001012014)

摘　　要：目的:探讨左心房心内膜去神经化射频消融治疗难治性血管迷走性晕厥(VVS)的安全性和有效性。方法:连续纳入57例症状严重、倾斜试验结果为阳性的难治性VVS患者,男性22例,平均年龄(43±14)岁,均对常规治疗无效或无法耐受。57例患者均采用三维标测系统重建左心房模型,于左心房的5个自主神经节(GP)解剖分布区域消融,行左心房心内膜去神经化射频消融治疗,观察消融术中出现血压下降、窦性心动过缓或窦性停搏、交界性逸搏等迷走反应情况,消融终点为迷走反应消失。术后定期随访,记录晕厥、晕厥前兆的发生情况并复查动态心电图和直立倾斜试验。结果:52例(91.2%)患者在消融中诱发出迷走反应,并达到消融终点,5例患者未能诱发出明显的迷走反应。平均随访(36±22)个月,52例(91.2%)患者未发生晕厥,其中11例仍有心悸、黑朦及头晕等晕厥前兆发生,但术后每年晕厥前兆发作次数[(1.9±0.9)次/年]较术前[(6.2±5.5)次/年]明显减低(P=0.028),自觉症状明显改善。5例患者VVS复发。所有患者均无并发症发生。结论:左心房心内膜去神经化射频消融治疗难治性VVS安全、有效,能有效预防VVS复发。Objective： To explore the safety and efficacy of left atrial（LA） endocardial vagal denervation catheter ablation for treating the patients with refractory vasovagal syncope（VVS）.Methods： A total of 57 consecutive refractory VVS patients with severe symptom and positive response to head-up tilt test（HUT） were enrolled. There were 22 male at the mean age of（43 ± 13） years. The patients had no response or couldn＇t tolerate routine treatment. LA model was re-established by three-dimensional mapping system, 10 patients received highfrequency stimulation technique for ganglionated plexi（GP） ablation and 47 received regional catheter ablation at 5 anatomic sites of GP for LA endocardial vagal denervation treatment. In-operative vagal response including hypotension, sinus bradycardia or asystole were observed, the endpoint of ablation was abolition of evoked vagal reflexes. Periodical follow-up was conducted to record the syncope recurrence and to re-examine ECG and HUT in all patients. Results： There were 52/57（91.2%） patients had positive vagal response by radiofrequency application and reached the endpoint of ablation; 4 patients couldn＇t receive obvious evoked vagal reflexes. During（36 ± 22） months follow-up period, there were 52（91.2%） cases without syncope recurrence, 11 cases still having palpitation, amaurosis and dizziness as the precursors of syncope while the symptoms were much better then they were before. No complication occurred. Conclusion： LA endocardial vagal denervation catheter ablation is a safe and effective method for treating the patientswith refractory VVS, it may also effectively prevent VVS recurrence.

关 键 词：晕厥 血管迷走性 心内膜 导管消融术 

分 类 号：R54[医药卫生—心血管疾病]