迷走神经消融治疗高强度训练患者症状性缓慢性心律失常的效果  

The effect of modified right-atrial-only cardioneuroablation on symptomatic bradyarrhythmias due to high-intensity training patients

作　　者：罗涛 史成龙 戴颖 陈炳伟 Luo Tao;Shi Chenglong;Dai Ying;Chen Bingwei(Department of Cardiology,983th Hospital of Joint Logistic Support Force of People's Liberation Army of China,Tianjin 300142,China;Department of Cardiology,Tianjin First Central Hospital,Tianjin 300190,China)

机构地区：[1]联勤保障部队第九八三医院心血管内科,天津300142 [2]天津市第一中心医院心血管内科,天津300190

出　　处：《中华心律失常学杂志》2025年第1期14-19,共6页Chinese Journal of Cardiac Arrhythmias

基　　金：天津市卫健委科研课题(2021145);医院重点项目课题(983YN22F003)。

摘　　要：目的探究右心房改良迷走神经消融治疗因高强度训练导致症状性缓慢性心律失常的效果。方法本研究为前瞻性队列研究。连续纳入2022年1月至2023年12月在联勤保障部队第九八三医院因高强度训练导致症状性缓慢性心律失常就诊的患者(包括窦房结和房室结功能紊乱)。根据电生理检查结果,在解剖学定位+碎裂电位指导下的消融上间隔旁迷走神经丛和/或下间隔旁迷走神经丛,通过电生理参数[如心率校正后窦房结恢复时间(cSNRT)、文氏周期(WCL)、房室结前传不应期(ANARP)等]评估即刻消融终点,并对术后症状负荷、24 h动态心电图心率变异性指标如全部正常窦性心搏间期(NN)的标准差(SDNN)、全程相邻NN间期之差的均方根值(rMSSD)、NN50除以总的NN间期个数百分比(PNN50%)等进行随访和分析。结果纳入42例患者,年龄(24.3±7.5)岁,其中男36例。右心房迷走神经消融术后,患者窦房结恢复时间(SNRT)、cSNRT、PR间期和AH间期较术前均明显缩短(P<0.01),而HV间期则保持不变(P>0.01)。WCL较术前降幅为32.25%±5.45%,ANARP较术前降幅为35.67%±6.83%,术后即刻心率较术前明显增加[(52.8±8.1)次/min对(71.6±4.6)次/min,P<0.0001],术后6个月心率变异性指标SDNN[(157±13)ms对(84±17)ms,P<0.0001]、rMSSD[(42±12)ms对(12±2)ms,P<0.0001]、PNN50%[(16±10)对(1±1),P<0.0001]较术前均明显下降,提示迷走神经张力降低。术后12个月随访,仅1例患者症状复发,动态心电图提示夜间间歇性MobizⅡ型房室传导阻滞,再次行迷走神经消融治疗;术后随访2年期间,其余患者均无明显症状且24 h动态心电图结果呈阴性,无任何手术相关并发症。结论单纯右心房改良迷走神经消融治疗高强度训练导致的症状性缓慢性心律失常患者临床效果满意,有助于患者重返工作岗位参加高强度训练。ObjectiveTo investigate the effect of modified right-atrial-only cardioneu-roablation(CNA)on symptomatic bradyarrhythmias caused by high-intensity training.MethodsThis was a prospective cohort study.Consecutive patients(including sinus node and atrioventricular node dysfunction)who admitted to 983th Hospital of Joint Logistic Support Force of People's Liberation Army from January 2022 to December 2023 with symptomatic bradyarrhythmias due to high-intensity training were enrolled.Based on electrophysiological examination,ablation of the superior paraseptal vagal plexi(SPSGP)and/or inferior paraseptal vagal plexi(IPSGP)guided by anatomical localization with fragmentation potentials,acute ablation endpoints were assessed by electrophysiological parameters[such as heart rate-corrected sinus node recovery time(cSNRT),the Wenckebach cycle length(WCL),and atrioventricular node anterograde refractory period(ANARP)],and the post-CNA symptom burden,24 h holter heart rate variability indices such as standard deviation of NN intervals(SDNN),root mean square of successive differences(rMSSD),percentage of normal-to-normal intervals exceeding 50 ms(PNN50%)were followed up for analysis.ResultsA total of forty-two patients,aged(24.3±7.5)years,including 36 males,were enrolled.Electrophysiological examination post-CNA showed that sinus node recovery time(SNRT),cSNRT,PR interval and AH interval were significantly shorter than pre-CNA(P<0.01),whereas HV interval remained unchanged(P>0.01).The WCL decreased by 32.25%±5.45%compared to pre-CNA,and the ANARP decreased by 35.67%±6.83%,heart rate increased significantly[(52.8±8.1)bpm vs.(71.6±4.6)bpm,P<0.0001].The indices of heart rate variability at 6 months post-CNA,SDNN[(157±13)ms vs.(84±17)ms,P<0.0001],rMSSD[(42±12)ms vs.(12±2)ms,P<0.0001],and PNN50%[(16±10)vs.(1±1),P<0.0001]were significantly decreased,suggesting a reduction in vagal tone.At the 12-month follow-up,only one patient had a recurrent symptoms,and the Holter electrocardiogram showed nocturnal intermittent Mobiz

关 键 词：导管消融术 心脏神经消融术 迷走神经丛 高强度训练 症状性缓慢性心律失常 右心房 

分 类 号：R541.7[医药卫生—心血管疾病]