心房神经节丛消融术对症状性窦性心动过缓的治疗效果  

Effect of atrial ganglionated plexus ablation on symptomatic sinus bradycardia

作　　者：汪师逸 宋子良 刘洋[1] 吴绍辉 姜伟峰 张宇 刘旭[1] 秦牧 Wang Shiyi;Song Ziliang;Liu Yang;Wu Shaohui;Jiang Weifeng;Zhang Yu;Liu Xu;Qin Mu(Department of Cardiology,Shanghai Chest Hospital,School of Medicine,Shanghai Jiao Tong University,Shanghai 200025,China)

机构地区：[1]上海交通大学医学院附属胸科医院心内科,上海200025

出　　处：《中华心律失常学杂志》2025年第1期33-39,共7页Chinese Journal of Cardiac Arrhythmias

基　　金：国家自然科学基金(81770324)。

摘　　要：目的探讨心房神经节丛(GP)消融对有症状的窦性心动过缓患者的长期治疗效果。方法本研究为前瞻性观察队列研究。纳入2015年4月至2018年12月在上海交通大学医学院附属胸科医院的所有出现症状性窦性心动过缓患者,通过连续或简化方法对GP进行消融,GP消融术前均接受窦房结功能和24 h动态心电图检查。随访2年,评估患者的心率、症状和生活质量变化情况。结果纳入73例患者,其中男38例,年龄(51.2±11.9)岁。46例患者接受连续的GP消融,27例接受简化的GP消融。GP消融术后,与基线心率相比患者术后心率显著增加并稳定,差异具有统计学意义[(50.4±4.1)次/min对(69.2±6.5)次/min,t=20.90,P<0.001]。两种消融方法在消融过程中的心率增加,差异无统计学意义[(19.5±6.8)次/min对(20.5±5.9)次/min,t=0.64,P=0.485]。最后一次随访(术后2年)时,所有患者的心率仍显著高于基线心率[(61.7±8.7)次/min对(50.4±4.1)次/min,t=10.04,P<0.001],但术后超过2年,随访发现心率开始显著下降。年龄与心率增加呈负相关,差异有统计学意义(r=-0.69,P<0.001)。结论GP消融可有效提高症状性窦性心动过缓患者的窦性心率并改善其生活质量,但2年后效果逐渐下降。ObjectiveTo investigate the long-term therapeutic effect of atrial ganglion plexus(GP)ablation symptomatic sinus bradycardia(SB).MethodsThis study was a prospective,observational,cohort study.Patients with symptomatic SB between April 2015 and December 2018 were enrolled.The atrial GPs were ablated by sequential or simplified methods.All patients underwent sinus node function tests and 24-hour electrocardiogram monitoring before GP ablation.Heart rate(HR),symptoms and quality of life were assessed with 2 years of follow-up.ResultsA total of 73 patients were enrolled.The age was(51.2+11.9)years,and 38 patients were men.Forty-six patients were underwent sequential GP ablation,and 27 patients were underwent simplified GP ablation.After GP ablation,the HR increased significantly and stabilized at(69.2±6.5)bpm compared with baseline HR[(50.4±4.1)bpm,t=20.90,P<0.001].There was no significant difference in the increase of HR during the ablation process between the two methods[(19.5±6.8)bpm vs.(20.5±5.9)bpm,t=0.64,P=0.485].At the last follow-up,the average HR of all patients was still significantly higher than baseline HR[(61.7±8.7)bpm vs.(50.4±4.1)bpm,t=10.04,P<0.001],But it began to decline significantly after more than two years follow-up.Age was negatively correlated with HR(r=-0.69,P<0.001).ConclusionGP ablation approach effectively increases the sinus rhythm and improves the quality of life in patients with symptomatic SB,but the effect gradually declines over two years.

关 键 词：导管消融术 神经节神经丛 自主神经修饰 长期随访 窦性心动过缓 

分 类 号：R541.7[医药卫生—心血管疾病]