心脏神经结丛消融联合低强度耳屏迷走神经刺激对犬房颤电生理特性的影响  

Effects of cardiac plexus ablation combined with low intensity tragus vagus nerve stimulation on electrophysiological characteristics of atrial fibrillation in dogs

作　　者：杨志[1] 张峰 雷芾华 程文波[3] 侯月梅[3] Yang Zhi;Zhang Feng;Lei Fuhua;Chen Wenbo;Hou Yuemei(Department of Cardiology,Changji Branch of the First Affiliated Hospital of Xinjiang Medical University,Changji 831199,China;Department of Cardiology,Jinshan Hospital of Fudan University,Shanghai 201508,China;Department of Geriatrics,Shanghai Jiao Tong University Affiliated Sixth People's Hospital South Camplus,Shanghai 201400,China)

机构地区：[1]新疆医科大学第一附属医院昌吉分院心血管内科,新疆昌吉831199 [2]复旦大学附属金山医院心内科,上海201508 [3]上海交通大学附属第六人民医院南院老年科,上海201400

出　　处：《中华临床医师杂志（电子版）》2021年第5期370-374,共5页Chinese Journal of Clinicians(Electronic Edition)

基　　金：国家自然科学基金(81670308);上海市科委创新行动计划(20Y11909900)。

摘　　要：目的研究心脏神经节丛消融联合低强度耳屏迷走神经刺激对阵发性犬心房颤动(简称房颤)电生理特性的影响,探讨低强度耳屏迷走神经刺激对房颤消融术后的治疗价值。方法21条健康成年比格犬随机分为3组:RAP组(500次/min快速心房起搏,n=7)、ABL组(心脏神经节消融+500次/min快速心房起搏,n=7)、LL-ST组(心脏神经节消融+低强度右侧耳屏刺激+500次/min快速心房起搏,n=7)。其中,RAP组为单纯快速心房起搏,ABL组为右上神经节丛(ARGP)和左上神经节丛(LSGP)消融后快速心房起搏,LL-ST组为ARGP+LSGP消融后低强度刺激右侧耳屏迷走神经+快速心房起搏。于起搏前及起搏后2、4、6、8、10、12、14、16 h测定犬心房和肺静脉不同部位的房颤诱发率、房颤持续时间、有效不应期(ERP)及有效不应期离散度(dERP)。结果(1)与RAP组相比,LL-ST组房颤诱发率显著降低,房颤持续时间显著减少,ERP显著延长,dERP显著降低,差异有统计学意义(P均<0.05)。(2)与ABL组相比,LL-ST组房颤诱发率显著降低,房颤持续时间显著减少,ERP显著延长,dERP显著降低,差异均有统计学意义(P<0.05)。结论低强度右侧耳屏迷走神经刺激联合心脏神经节丛消融可以有效控制房颤消融术后的复发。Objective To study the effect of cardiac ganglion plexus ablation combined with low intensity tragus vagus nerve stimulation on electrophysiological characteristics in a dog model of atrial fibrillation,and to explore the value of tragus vagus nerve stimulation in preventing the recurrence of atrial fibrillation after ablation.Methods Twenty-one adult beagle dogs were randomly divided into three groups:RAP group(n=7;500 times/min rapid atrial pacing),ABL group[n=7;ablation of the right superior ganglion plexus(ARGP)and left superior ganglion plexus(LSGP)+500 times/min rapid atrial pacing],and LL-ST group(n=7;ARGP and LSGP ablation+low intensity right ear vagus nerve stimulation+500 times/min rapid atrial pacing).At baseline and 2,4,6,8,10,12,14,and 16 h after pace-making,the inducibility and duration of atrial fibrillation,effective refractory period(ERP),and dispersion effective refractory period(dERP)in different locations of the atrium and pulmonary veins were detected.Results(1)Compared with RAP group,the inducibility and duration of atrial fibrillation were significantly reduced in the LL-ST group(P<0.05);the ERP was significantly prolonged and the dERP was significantly decreased(P<0.05).(2)Compared with ABL group,the inducibility and duration of atrial fibrillation were significantly reduced in the LL-ST group(P<0.05);the ERP was significantly prolonged and the dERP was significantly decreased(P<0.05).Conclusion Low intensity right tragus stimulation combined with cardiac ganglion plexus ablation can effectively control the recurrence of atrial fibrillation after ablation.

关 键 词：心房颤动 神经电刺激 迷走神经 心脏神经节丛 消融 

分 类 号：R541.75[医药卫生—心血管疾病]