心房颤动冷冻消融顺序对迷走神经反射及心率变异性的影响:一项回顾性队列研究  

Influence of cryoablation ablation sequence in atrial fibrillation on vagal reflex and heart rate variability: a retrospective cohort study

作　　者：胡菁[1] 方雁[1] 赖珩莉[1] 常智堂[1] 邹晋 汪启均 HU Jing;FANG Yan;LAI Hengli;CHANG Zhitang;ZOU Jin;WANG Qijun(Department of Cardiology,Jiangxi Provincial People's Hospital,First Affiliated Hospital of Nanchang Medical College,Nanchang,330006,China)

机构地区：[1]江西省人民医院(南昌医学院第一附属医院)心血管内科,南昌330006

出　　处：《临床心血管病杂志》2024年第7期560-564,共5页Journal of Clinical Cardiology

基　　金：江西省卫生健康委科技计划(No:202410144、202410138)。

摘　　要：目的:评估冷冻消融过程中肺静脉消融顺序对迷走神经反射及心率变异性(HRV)的影响。方法:回顾性分析2020年1月1日—2023年6月30日在我院进行阵发性心房颤动(房颤)冷冻球囊消融术的患者114例。根据冷冻消融顺序,将患者分为先消融右上肺静脉组(RSPV组,57例)及先消融左上肺静脉组(LSPV组,57例)。比较两组迷走神经反射事件及HRV指标。结果:在冷冻消融过程中,与LSPV组相比,RSPV组迷走神经反射发生率明显降低(28.1%vs 1.8%,P<0.000 1)。其中,RSPV组发生迷走神经反射1例,表现为窦性心动过缓;LSPV组发生16例,表现为窦性心动过缓、房室传导阻滞、心脏停搏(均需要起搏)及低血压。LSPV组与RSPV组消融术后SDNN、SDANN、rMSSD及LF/HF均较术前明显下降(均P<0.05),但两组间各项指标相比较均差异无统计学意义。结论:房颤冷冻消融先右肺静脉后左肺静脉的消融顺序能明显减少迷走神经反射的发生。消融后HRV明显下降,但HRV的变化与消融顺序无关。Objective To evaluate the impact of the sequence of pulmonary vein ablation during cryoablation on vagal reflex and heart rate variability (HRV).Methods A retrospective analysis was conducted on 114 paroxysmal atrial fibrillation patients who underwent cryoballoon ablation at our institution from January 1, 2020 to June 30, 2023.Patients were divided into two groups based on the sequence of cryoablation: the firstly right superior pulmonary vein ablation group (RSPV, n=57) and the firstly left superior pulmonary vein ablation group (LSPV group, n=57).Vagal reflex events and heart rate variability indicators between the two groups were compared.Results During cryoablation, the RSPV group had a significantly lower incidence of vagal reflex compared to the LSPV group (28.1% vs 1.8%, P < 0.000 1).Only one case of vagal reflex, manifested as sinus bradycardia, occurred in the RSPV group, while 16 occurred in the LSPV group manifested as sinus bradycardia, atrioventricular block, cardiac arrest (all patients required pacing), and hypotension.Heart rate variability indicators SDNN, SDANN, rMSSD, and LF/HF decreased significantly after ablation compared to those before ablation in the LSPV and RSPV groups (all P < 0.05), but there was no statistically significant difference in the above indicators between the two groups.Conclusion Starting cryoablation from the right pulmonary vein, followed by the left pulmonary vein, significantly reduces the occurrence of vagal reflex during atrial fibrillation cryoablation.While HRV decreases significantly after ablation, the change in HRV is not related to the sequence of ablation.

关 键 词：冷冻消融 迷走神经反射 心率变异性 心房颤动 

分 类 号：R541.7[医药卫生—心血管疾病]