肺静脉口周消融造成去迷走效应对心房颤动消融效果的影响

Effect of vagal denervation resulted from ablation around pulmonary vein ostium on atrial fibrillation ablation

目的观察肺静脉口周消融术所造成的去迷走效应(vagaldenenvation,VD)对心房颤动(房颤)患者消融效果的影响。方法52例患者(男性44例,女性8例),其中12例为持续性房颤(1～22年),年龄22～70(51.1±10.9)岁,左心房内径22～54(36.1±6.5)mm。所有患者接受了等电位标测指导下的左心房内电学改良消融,包括肺静脉口周围的节段或环形消融。记录术中发生VD的消融位点,术后定期检查动态心电图,记录最低心率、最高心率、平均心率、SDNN、rMSDD并与术前进行比较。结果52例患者中有34例于术中出现明确的VD现象(VD阳性组),其中左上肺静脉口25例,右下肺静脉口10例,右上肺静脉口4例,左下肺静脉口4例。随访(11.0±6.2)个月,42例消融成功,8例有非典型性心房扑动。VD阳性组疗效明显高于VD阴性组(96.7%vs58.8%,P=0.01)。VD阳性组患者术前平均心率、最低心率、最高心率、SDNN、rMSSD分别为76.63、42.88、138.88、156.95、32.22,术后分别为89.12、52.22、141.50、152.53、19.24差异均有统计学意义(P<0.05);VD阴性组患者术前平均心率、最低心率、最高心率、SDNN、rMSSD分别为77.33、49.60、143.20、147.00、32.22,术后分别为78.13、49.73、143.33、143.98、38.37,差异均无统计学意义(P>0.05)。术后6个月时,VD阳性组患者心率增快、心率变异性降低仍然持续存在。结论肺静脉口周围消融过程中发生去迷走效应可伴有房颤消融成功率的明显增加,发生去迷走效应的位点大多位于左上肺静脉口周围,此效应似乎可维持相当长的时间。

Objective To evaluate the impact of vagal denervation (VD) derived from ablation around pulmonary vein ostium on atrial fibrillation (AF) ablation. Methods There were 52 patients (male in 44, female in 8), whose age was 22～70(51.1±10.9) years. Of them, 12 cases were persistent AF. The mean diameter of left atrium (LA) was 22～54(36.1±6.5)mm. Left atrial electrical modification catheter ablation was made under the isopotential mapping with Ensite 3000.Target sites with VD were recorded during ablation.And periodical Holter monitoring was made for mean heart rate (Mean HR), marximal heart rate (Marx HR), minimum heart rate (Mini HR), SDNN and rMSSD both before and after the ablation procedure. Results VD was observed in 34 patients with the most common target sites located around left-superior pulmonary veins (25 cases), right-inferior pulmonary veins (10 cases),right-superior pulmonary veins (4 cases), and left-inferior pulmonary veins (4 cases). Follow-up results showed that after (11.0±6.2) months, 42 patients experienced no AF while 8 patients experienced atypical atrial flutter. Patients with VD effects felt much better compared to those without VD effects (96.7% vs 58.8%, P=0.01). The parameters of Mean HR, Marx HR, Mini HR, SDNN and rMSSD were 76.63、42.88、138.88、156.95、32.22 in VD-positive patients before ablation, while the parameters were changed to 89.12、52.22、141.50、152.53、19.24 after ablation, P<0.05. The parameters of Mean HR, Marx HR, Mini HR, SDNN and rMSSD were 77.33、49.60、143.20、147.00、32.22 in VD-negative patients before ablation, while the parameters were changed to 78.13、49.73、143.33、143.98、38.37 after ablation, P>0.05. VD-positive patients experienced increased heart rate and decreased heart rate variation over a continued period of 6 months or more. Conclusions The VD effects derived from ablation around pulmonary vein greatly improve the successful rates of AF ablation, with the most common VD sites located around left-superior pulmonary veins and the effect seems to persist for a rather long time.