肺静脉前庭扩大冷冻消融术中迷走神经反射的预测及防治  

Prediction and prevention of vagal reflex during extended pulmonary vein antrum cryoballoon ablation

作　　者：沈利水 卢小华 阿塔吾拉·艾力 董珍珍 许小朋 汤岐梅 李云红 唐恺[1] Shen Lishui;Lu Xiaohua;Atawula·Aili;Dong Zhenzhen;Xu Xiaopeng;Tang Qimei;Li Yunhong;Tang Kai(Department of Cardiology,Shanghai Tenth People's Hospital,Shanghai 200072,China)

机构地区：[1]上海市第十人民医院心内科,上海200072

出　　处：《中华心律失常学杂志》2025年第1期26-32,共7页Chinese Journal of Cardiac Arrhythmias

摘　　要：目的探讨心房颤动(房颤)肺静脉前庭扩大冷冻消融术中发生迷走神经反射(迷走反射)的预测因素及处理方案。方法本研究为单中心回顾性队列研究。连续入选2020年1月至2021年7月上海市第十人民医院行第二代冷冻球囊导管消融治疗的药物难治性房颤患者,根据是否发生迷走反射,分为迷走反射组和非迷走反射组,比较两组患者的基线资料和冷冻消融术中消融部位等的差异,分析和总结发生术中迷走反射的危险因素及治疗方案。结果纳入417例患者,年龄(67.5±8.6)岁,其中男57.3%(239/417)。阵发性房颤271例,持续性房颤146例。146例(35.0%,146/417)患者在肺静脉前庭扩大冷冻消融术中发生迷走反射,其中125例(85.6%,125/146)发生于消融左上肺静脉,10例(6.8%,10/146)于左下肺静脉,20例(13.7%,20/146)于左肺静脉前庭扩大消融部位,1例于右上肺静脉。8例(5.5%,8/146)患者在左上肺静脉消融和左肺静脉前庭扩大消融时均出现迷走反射。多因素Logistic回归分析显示较慢的基础心率(OR=0.99,95%CI 0.97~1.00,P=0.047)、较低的体重指数(OR=0.93,95%CI 0.87~0.99,P=0.025)和较低的左上肺静脉最低消融温度(OR=0.95,95%CI 0.91~0.99,P=0.024)均是冷冻消融期间发生迷走反射的独立危险因素。术中进行心室导线起搏、静脉快速补液、静脉推注阿托品0.5~1.0 mg可使97.3%(142/146)患者恢复血压及心率。结论肺静脉前庭扩大冷冻消融期间迷走反射较为常见,较慢的基础心率、较低的体重指数和较低的左上肺静脉最低消融温度与术中发生迷走反射相关。ObjectiveTo investigate the predictive factors and treatment strategies of vagal reflex during extended pulmonary vein antrum cryoballoon ablation in patients with atrial fibrillation(AF).MethodsThis was a retrospective cohort study.Patients with drug-refractory AF who underwent second-generation cryoballoon ablation in Shanghai Tenth People's Hospital between January 2020 and July 2021 were consecutively enrolled.These patients were further divided into the vagal reflex group and the non-vagal reflex group according to the vagal response during the ablation procedure.The baseline data and procedural parameters of two groups were compared,and the risk factors and treatment options for intraoperative vagal reflex were summarized.ResultsA total of 417 patients[age,(67.5±8.6)years;male,57.3%(239/417)]were enrolled,including 271 paroxysmal AF patients and 146 persistent AF patients.One hundred and forty-six patients(35.0%,146/417)experienced vagal reflex during the procedure,of whom 125(85.6%,125/146)occurred in the ablation of the left upper pulmonary vein,10(6.8%,10/146)in the left inferior pulmonary vein,20(13.7%,20/146)in the extended left pulmonary vein antrum ablation site,and 1(0.7%,1/146)in the right superior pulmonary vein.Eight patients(5.5%,8/146)occurred vagal reflex both in the left superior pulmonary vein and the extended left pulmonary vein antrum ablation.Multivariate Logistic regression analysis showed that slower basal heart rate(OR=0.99,95%CI 0.97-1.00,P=0.047),lower body mass index(OR=0.93,95%CI 0.87-0.99,P=0.025)and lower minimum ablation temperature of left superior pulmonary vein(OR=0.95,95%CI 0.91-0.99,P=0.024)were independent risk factors for vagal reflex during cryoballoon ablation.The therapies of ventricular pacing,intravenous infusion,and atropine injection(0.5-1.0 mg)could restore the blood pressure and heart rate in 97.3%(142/146)of the patients with vagal reflex.ConclusionVagal reflex is common during extended pulmonary vein antrum cryoballoon ablation.Slower basal heart rate,lower bo

关 键 词：心房颤动 冷冻消融 肺静脉前庭 迷走反射 自主神经节丛 

分 类 号：R541.7[医药卫生—心血管疾病]