窦性冲动疏导术治疗心房颤动的动物实验研究

Sinus impulse dredging procedure——a new surgical approach in treatment for atrial fibrillation

目的 为了建立一种全新的心房颤动 (房颤 )外科治疗手术方式 ,对 5只杂种犬实行了窦性冲动疏导术。 方法 5只杂种犬开胸后在心外膜行短阵快速刺激 (burst) ,其中 2只诱导出房颤 ,3只诱导出心房扑动 (房扑 )。然后实行窦性冲动疏导术。手术方法是将右房切口设计为界嵴 (cristaterminalis)前、后两切口以及自右心耳终止于三尖瓣环的切口 ,以保护前、后结间束、窦房结动脉和右房上部的窦性冲动发生区。左房切口为一连接各肺静脉口的“υ”字形切口 ,以保护左房的正常传导通路和窦房结动脉。这一左房的υ形切口终止于二尖瓣环 ,不会围绕左房切口线形成新的折返激动。 结果 术后原条件行短阵快速刺激不能诱发出房颤或房扑。PR间期正常 ,左、右房收缩同步。左房后壁收缩良好。 结论 窦性冲动疏导术后使窦性冲动传导和左房输送功能达到更好的恢复 ,还使手术更容易实施。

Objective To develop a new surgical procedure for preserve better left atrial transport function. Methods Five dogs underwent sinus impulse dredging procedure. Every dog was stimulated with burst pacing to induce atrial fibrillation or flutter,2 of them had atrial fibrillation and 3 atrial flutter. The procedure included two incisions on the right atrium anterior and posterior to criasta terminalis, to keep the crista terminalis undamaged,and a right appendage incision terminated at tricuspid annulus. Left atrium incision was a 'υ' shape incision connecting orifices of the pulmonary veins to preserve normal conduction via Bachmann's tract and the conduction pathway beneath the two inferior pulmonary veins in left atrium,to protect left sinus artery from damage.This υ shape incision in left atrium terminated at mitral annulus,so that,nonew reentrant movement around the υ shape incision could generate after operation. Results After operation,no atrial fibrillation or atrial flutter could be induced in the 5 dogs.30 min after operation PR intervals were the same as preoperation. Both left and right atria were contracting simultaneously. Posterior wall of the left atrium could contract strongly. Conclusion Sinus impulse dredging procedure can preserve the conduction between sinus node and atrioventricular node and conduction in right and left atrium, as well as the conduction between atria. It can also preserve the transport function of left atrium, and above all,the sinus impulse dredging procedure is safe and easy to perform.