Marshall韧带消融对心肌不应期和心肌梗死后室性心律失常的影响  

Effects of Marshall Ligament Ablation on Myocardial Refractory Period and Post- infarction Ventricular Arrhythmias

作　　者：何文博[1] 余小梅[1] 鲁志兵[1] 何勃[1] 谢菁[1] 王松云[1] 黄兵[1] 江洪[1] 

机构地区：[1]武汉大学人民医院心血管内科、武汉大学心血管病研究所,430060

出　　处：《医学研究杂志》2016年第11期28-31,共4页Journal of Medical Research

基　　金：国家自然科学基金资助项目(81400254,81370281,81300181);湖北省自然科学基金杰出青年人才项目(2015CFA051)

摘　　要：目的研究Marshall韧带消融对心肌有效不应期和室性心律失常的影响。方法 21只杂种犬随机分为Marshall韧带消融组(n=11)和对照组(n=10)。记录左、右心房和左、右心室不同部位的电图,并测量各部位有效不应期(effective refractory period,ERP),计算ERP的空间离散度。消融组实验犬采用大头电极对Marshall韧带进行消融,消融后再次测量ERP,计算ERP离散度。对照组犬不行消融。测量结束后,结扎冠状动脉左前降支,持续体表心电图记录1h,记录室性心律失常发生情况。结果与基础状态相比,Marshall韧带消融后左、右心室和右心房的ERP显著延长,左心房的ERP变化不显著,心房和心室的ERP离散度在消融前后无显著差异。结扎冠脉左前降支后,消融组的室性期前收缩数和室性心动过速阵数显著低于对照组,消融组的心室颤动和室性心动过速发生率与对照组差异无统计学意义(P>0.05)。结论 Marshall韧带消融可延长犬左、右心室和右心房的ERP,而对ERP离散度无显著影响。Marshall韧带消融对心肌梗死后室性心律失常的发生可能有保护作用。Objective To investigate the effect of Marshall ligament ablation on myocardial effective refractory period and ventrieular arrhythmogenesis. Methods Twenty - one mongrel dogs were randomly divided into ablation group （ n = 11 ） and control group （ n = 10）. Electrograms were recorded at different sites on both ventricles and atria. Effective refractory period （ERP） was measured and the spatial dispersion of ERP was calculated before and after ablation of ligament of Marshall. In the control group ablation was not performed. Then the left anterior descending coronary artery was ligated and surface ECG was continuously recorded for 1 hour to observe the occur- rence of ventricular arrhythmias. Results Compared with baseline, ERPs of right atrium, left ventricle and right ventricle were all in- creased after ablation of ligament of Marshall, while ERP of left atrium was not changed significantly. The dispersion of ERP was not changed before and after ablation. After ligation of left anterior descending coronary artery, the occurrences of premature ventricular beats and ventricular tachycardia in ablation group were significantly less frequent than in control group, while the incidences of ventricular tach- ycardia and ventricular fibrillation were not significantly different between two groups. Conclusion The ablation of ligament of Marshall could prolong the ERPs of right atrium and both ventricles in canines, but showed no evident effect on ERP dispersions. The ablation of ligament of Marshall might have a protective role against post -infarction ventricular arrhythmias.

关 键 词：MARSHALL韧带 室性心律失常 有效不应期 

分 类 号：R541.7[医药卫生—心血管疾病]