消融Marshall韧带减少心肌梗死后室性心律失常的实验研究  

Ablation of the ligament of Marshall to reduce ventricular arrhythmias during acute myocardial infarction

作　　者：王晓莹 余小梅[1] 刘珊[1] 罗达 瞿唯一 陈超 马瑞松 胡慧慧[1] 谢菁[1] 鲁志兵[1] WANG Xiao-ying;YU Xiao-mei;LIU Shan;LUO Da;QU Wei yi;CHEN Chao;MA Rui song;HU Hui-hui;XIE Jing;LU Zhi-bing(Department of Cardiology,Renmin Hospital of Wuhan University,Cardiovascular Research Institute of Wuhan University,Hubei Key Laboratory of Cardiology,Wuhan 430060,China)

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心血管病湖北省重点实验室,湖北武汉430060

出　　处：《中国心脏起搏与心电生理杂志》2018年第5期468-473,共6页Chinese Journal of Cardiac Pacing and Electrophysiology

摘　　要：目的研究射频消融Marshall韧带(LOM)远段对犬急性心肌梗死(简称心梗)后室性心律失常的影响。方法实验一:记录10只健康成年雄性犬基础状态血压、心率、心率变异性性、心室有效不应期及左侧星状神经节刺激引起血压升高的程度。测量结束后,将多极电极贴于LOM表面以记录到其电位确认消融部位后行射频消融,30min后重复测量上述指标,比较消融前后的变化。实验二:25只健康成年雄性犬随机分为对照组(不消融,n=13)、消融组(LOM远段消融,n=12),对照组仅将消融电极置于LOM远段但不给予消融能量,消融完成后结扎冠状动脉左前降支构建急性心梗模型,监测1h内室性心律失常事件。实验结束后,大体神经解剖观察LOM神经通路及走行,取正常LOM组织做苏木精-伊红(HE)和免疫组织化学染色。结果实验一:与基础状态相比,消融LOM远段可降低交感神经张力、减弱刺激LSG时血压上升幅度、延长心室有效不应期。实验二:与对照组相比,消融组心梗后室性早搏的次数、非持续性室性心动过速事件和持续时间均明显减少。大体解剖显示LSG与LOM之间有神经纤维联系,且免疫组化结果证实LOM远段富含交感神经纤维。结论 LOM远段富含交感神经,可能是LSG连接心室的交感神经解剖通路。消融LOM远段可降低心脏交感神经活性,抑制LSG功能,减少急性心梗后室性心律失常事件的发生。Objective To investigate the effect of radiofrequency ablation of the distal part of the ligament of Mar- shall （LOMLSPV） on the ventricular arrhythmia after acute myocardial infarction （AMI） of the canine. Methods Protocol 1 ： blood pressure, heart rate, heart rate variability, ventricular effective refractory period and the elevation of blood pressure in response to the stimulation of left stellate ganglion were recorded in 10 adult male dogs before and after the ablation of LOMLSPV. At the end of the measurement, a multi-electrode catheter was sutured along the entire length of LOM to record the potentials and locate the distal part of LOM . Protocol 2：25 adult male dogs were anesthetized with 3% sodium pentobarbital and were randomly divided into control group （sham ablation, n = 13）, ablation group （LOMLSPV ablation, n = 12）. Left anterior descending coronary artery occlusion was performed to induce AMI model and ventricular arrhythmia was recorded within 1 hour. The normal LOM tissue were resected for hematoxylin ＆ eosin staining, as well as immunohistochemical staining Results Protocol 1： Compared with the basal state, ablation of LOMLSPV could reduce the sympathetic tone, weaken the increase of blood pressure caused by stimulating LSG and prolong the ventricular effective refractory period. Protocol 2： The number of premature ventricular contractions, the number and duration of non-sustained ventricular tachycardia events were sig nificantly reduced in LOMLSPV ablation group when compared with the control group. Gross anatomy showed that there were nerve fiber connections between LSG and LOM, and inlmunohistochemistry results confirmed that abundant sympathetic nerve bundles distributed in LOMLSPV. Conclusion LOMLSPV is rich in sympathetic nerve and maybe serves as an important anatomical path- way between LSG and ventricle. Ablation of LOMLSPV can reduce cardiac sympathetic activity, inhibit LSG function and reduce the incidence of ventricular arrhythmias after acute myocardial

关 键 词：心血管病学 MARSHALL韧带 室性心律失常 心肌梗死 自主神经系统 

分 类 号：R454.1[医药卫生—治疗学] R541.7[医药卫生—临床医学]