消融Marshall韧带远段可降低交感神经活性减轻犬急性心房电重构  

Effects of selective ablation of the ligament of Marshall attenuated acute atrial electrical remodeling via decreasing cardiac sympathetic nerve activity

作　　者：刘珊[1] 鲁志兵[1] 余小梅[1] 秦智亮 罗达 胡慧慧[1] 王晓莹 马瑞松 何文博[1] 何勃[1] 谢菁[1] 江洪[1] 

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

出　　处：《中华心律失常学杂志》2017年第6期509-514,共6页Chinese Journal of Cardiac Arrhythmias

基　　金：国家自然科学基金（81370281、81270250）,湖北省自然科学基金杰青项目（2015CFA051）,中央高校基本科研业务费专项资金（2042016kf0118）

摘　　要：目的 探讨消融Marshall韧带远段对犬急性心房电重构的影响.方法 通过左心耳电极发放1200次/min电刺激,2倍起搏阈值进行6 h快速心房起搏（6 h-RAP）建立急性心房电重构模型.采用随机数字表法将16只成年雄性杂种犬随机分为两组：第1组（n=8）,6 h-RAP后立即消融Marshall韧带远段;第2组（n=8）,消融Marshall韧带远段后立即进行6 h-RAP.消融Marshall韧带远段前后记录心率变异性（HRV）,计算高频功率（HF,0.15～0.40 Hz）、低频功率（LF,0.04～0.15 Hz）以及低频/高频比值（LF/HF）.分别在基础状态、消融后和起搏每小时末测心房、心耳和肺静脉各部位的有效不应期（ERP）、心房颤动（房颤）的诱发窗口（WOV）.结果 消融Marshall韧带远段后,HF明显升高[（27.37±12.19）nu对（44.48±18.17）nu,P=0.0001],LF和LF/HF明显降低[LF：（48.42±18.45）nu对（30.77±16.14）nu,P=0.0000;LF/HF：（2.31±1.52）对（0.95±0.93）,P=0.0001].第1组各部位ERP在快速起搏的前2 h显著缩短,在起搏第3～6 h ERP维持稳定,而ERP离散度和各部位WOV的总和（ΣWOV）逐渐增宽,房颤易诱发.消融Marshall韧带远段后各部位的ERP较6 h-RAP末明显延长,而ERP离散度和ΣWOV显著降低（P均〈0.05）.第2组消融Marshall韧带远段后,各部位的ERP较基线明显延长,ΣWOV明显减小.随后在6 h-RAP过程中ERP离散度和ΣWOV无明显变化.起搏过程中第1组和第2组ERP均缩短,但第2组的缩短程度小于第1组（P〈0.05）.结论 消融Marshall韧带远段可减轻由6 h-RAP引起的急性心房电重构,其机制与降低心脏交感神经活性有关.Objective To investigate the effects of selective ablation of the ligament of Marshall （ LOM） on acute atrialelectrical remodeling induced by 6 hours rapid pacing （ 6 h-RAP ） . Methods The atrial fibrillation model was established by 6 h-RAP （1200 bpm,2× threhold,TH） at the left appendage.Sixteen adult male mongrel dogs were randomly divided into two groups by random number table.Group 1（ n=8）：6 h-RAP immediately followed by selective ablation LOM.Group 2（n=8）：selective ablation LOM followed by 6 h-RAP.Heart rate variability （HRV） were analyzed before and after LOMLSPV ablation.The effective refractory period （ERP） of atrial,appendage,and different sites of pulmonary veins,and the window of vulnerability （WOV） were respectively detected in the basic state, after ablation LOM and the ends of each hour during 6 h-RAP. Results After LOMLSPV ablation,LF components significantly decreased [（48. 42±18. 45） nu vs.（30. 77±16. 14） nu, P=0. 0000]. HF components significantly increased [（27. 37±12. 19） nu vs.（44. 48±18. 17） nu,P=0. 0001],and LF to HF ratio significantly reduced[（2. 31±1. 52） vs.（0. 95±0. 93）,P=0. 0001].In Group 1,ERP was significantly shortened in the first two hours and then stabilized. However, ERP dispersion and ΣWOV were progressively widened.After selective ablation LOM,atrial ERP was lengthened.ERP dispersion was declined.ΣWOV was narrowed （all P〈0. 05）.In Group 2,after selective ablation LOM,ERP was markedly increased andΣWOV were shortened compared with the basic state （all P〈0. 05）.During the 6 h-RAP,ERP dispersion andΣWOV remained unchanged. Atrial ERP was shortened during rapid atrial pacing in both groups. However, the reduction degrees of atrial ERP in Group 1 was greater than that in Group 2. Conclusion Selective ablation LOM can attenuate atrial electrical remodeling induced by 6 h-RAP. The possible mechanism might be related to the modulation of cardiac autonomic nervous activity.

关 键 词：MARSHALL韧带 射频消融 心房颤动 快速心房起搏 

分 类 号：R541.75[医药卫生—心血管疾病]