消融Marshall韧带远段对急性心力衰竭犬心房颤动易感性的影响  

Effects of ablation of the distal of the ligament of Marshall on vulnerability to atrial fibrillation in canines with acute heart failure

作　　者：瞿唯一 鲁志兵[1] 王晓莹 刘珊[1] 罗达 陈超 余小梅[1] 马瑞松 李元红 江洪[1] QU Wei-yi;LU Zhi-bing;WANG Xiao-ying;LIU Shan;LUO Da;CHEN Chao;YU Xiao-mei;MA Rui-song;LI Yuan-hong;JIANG Hong(Department of Cardiology, Renmin Hospital of Wuhan University Wuhan 430060, Hubei, China;Department of Cardiology, Central Hospital of Enshi Tujia and Miao Autonomous Prefecture,Enshi 145000, Hubei, 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湖北省心血管病重点实验室,湖北武汉430060 [2]湖北省恩施土家族苗族自治州中心医院心内科,湖北恩施445000

出　　处：《中国心脏起搏与心电生理杂志》2019年第2期138-143,共6页Chinese Journal of Cardiac Pacing and Electrophysiology

基　　金：国家自然科学基金资助项目(编号:81370281;81400250);湖北省自然科学基金杰青项目(编号:2015CFA051)

摘　　要：目的探讨消融Marshall韧带远段(LOM_(LSPV))对犬急性心力衰竭后心脏功能和心房颤动(简称房颤)易感性的影响。方法 20只健康杂种犬随机分为对照组(不消融,n=11)和消融组(LOM_(LSPV)消融,n=9)。于基础状态下行心脏超声检测左室舒张末期容积(LVEDV)、左室收缩末期容积(LVESV)、左室射血分数(LVEF)和左房内径(LAD),记录心率变异性(HRV)并测量心房、心耳和肺静脉各部位的有效不应期(ERP)、房颤诱发率。测量完毕,对照组将电极放置于LOM_(LSPV)但不予以消融能量,消融组使用多极电极在Marshall韧带记录到其电位后,行LOM_(LSPV)消融。两组均以200～240次/分快速起搏心室3 h,分别于起搏结束(PT)和起搏结束后3 h(PT-3 h)重复测量上述指标。结果与基础状态相比,消融组PT时LVEF降低, LF及LF/HF升高,心房和肺静脉各位点ERP缩短,房颤诱发率增加(P均<0.05)。与PT相比,消融组PT-3 h的LVEF仍有降低趋势(P>0.05),但LF及LF/HF降低,各位点ERP延长,总体房颤诱发率下降(P均<0.05)。与对照组相比,消融组于基础状态及PT各项数据无显著性差异(P均>0.05),而消融组PT-3 h的LVEF比对照组增加,LAD减小,LF和LF/HF降低,各位点ERP延长,总体房颤诱发率减少(P均<0.05)。结论消融LOM_(LSPV)可降低心脏交感神经活性,改善快速心室起搏所致急性心力衰竭犬的左室功能和左房内径,降低房颤易感性。Objective To investigate the effect of ablation of LOMLSPV on cardiac function and vulnerability to atrial fibrillation in acute heart failure canine model induced by rapid ventricular pacing. Methods Twenty adult male mongrel dogs were randomly subdivided into control(n=11) and ablation(n=9) group. Transthoracic 2-dimensional echocardiography, heart rate variability, and atrial electrophysiology parameters was measured. Ablation was carried out after measurement above, and before all dogs underwent 3-hour high-rate(200-240 bpm) ventricular pacing to induce acute heart failure. Repeat all the measurement at the terminus of pacing(PT) and 3 hours after the terminus of pacing(PT-3 h), respectively. Results Compared with baseline, rapid left ventricular pacing significantly, reduced the left ventricular ejection fraction, increased the LF components and LF/HF, shorten the atrial effective refractory period(ERP), elevated the atrial fibrillation induction rate(AFIR)(all P<0.05). When compared to the PT,LOMLSPVablation significantly,reduced the LF components and LF/HF,and prolonged atrial ERP,decreased the total AFIR(all P<0.05).In the ablation group,LVEF increased,LAD decreased,the LF components and LF/HF decreased,ERP prolonged,total AFIR decreased compared with the control group(all P<0.05). Conclusions LOMLSPVablation could reduce the cardiac sympathetic nerve activity by destroy the conduit of upstream sympathetic nerve to the heart,thereby improving left ventricular function and left atrial diameter,reducing the vulnerability to AF in canines with acute heart failure induced by rapid left ventricular pacing.

关 键 词：心血管病学 MARSHALL韧带 心力衰竭 心房颤动 射频消融 

分 类 号：R541.75[医药卫生—心血管疾病] R541.61[医药卫生—内科学]