去自主神经效应对环肺静脉消融房颤疗效的影响

Effect of Denervation on the Long-term Efficacy of Circumferential Pulmonary Vein Ablation of Paroxysmal Atrial Fibrillation

目的:探讨去自主神经效应对环肺静脉消融(CPVA)治疗心房颤动(房颤)的远期成功率的影响。方法:选择104例药物治疗无效的、有临床症状的阵发性房颤患者作为研究对象,所有患者均接受CPVA术。分别于术前、术后进行动态心电图检查,术后每3个月复查一次动态心电。随访房颤消融成功率(术后3个月无房颤被定义为无复发);并记录动态心电心率变异性(HRV)以反映自主神经功能。结果:本组研究共104例患者完成了CPVA术,平均手术次数为(1.35术次数为。变次,成功率为77.9%,共随访(24.27次数为。变异性个月。根据术后是否发生房颤,将患者分为成功组(81例)和复发组(23例),所有患者CPVA术后的时域和频域各项参数均显著降低(P<0.01),两组术后心率变异性(HRV)各项参数均较术前明显降低,成功组患者的SNDD、SDANN、r MSSD、PNN50、HF、TF、LF、VLF较对照组患者呈现不同程度的降低。结论:CPVA术可使心房出现去自主神经效应,进而增加去神经化效应,有利于提高其治疗房颤的远期成功率。

Objective： To study the effect of autonomic nerve denervation on long-term efficaey of CPVA in atrial fibrillation patients. Methods： 104 consecutive paroxysmal AF（PAF） patients with symptomatic and drug refractory AF were enrolled in this study.All patients underwent CPVA. During follow-up,24 hour Holter monitoring was performed before and after procedure. Then the patients accepted Holter examination every 3 months. Free of atrial tachyarrhythmias（〉30sec） during follow-up was regarded as no recurrence.Autonomic nerve denervation was assessed by heart rate variability（HRV） from Holter. Results： 104 patients finished the study.According to the outcome, the average operation time is（1.35 ±0.65）, the overall cumulative success rate was 77.9 %, the time of follow-up is（24.27±11.13）-month. All patients were divided into success group（81 cases） and recurrence group（23 cases）. After CPVA HRV decreased signiflcantly in each group. Furthermore,the characters of SDNN, r MSSD, PNN50, TF, VLF, LF and HF of success group were significantly lower than those of recurrence group（P〈0.05）. Conclusions： CPVA is an effective therapy for PAF, CPVA could induce autonomic nerve denervation, which may contribute to the long-term success of AF ablation.