迷走反应对阵发性心房颤动患者冷冻球囊消融的作用

Prediction of vagal reaction during cryoballoon ablation for the effect in patients with paroxysmal atrial fibrillation

目的在观察心房颤动（简称房颤）冷冻球囊消融术中迷走反应与术后房颤复发的相关性，分析其可能的机制。方法人选61例阵发性房颤患者，其中男38例，女23例，年龄（58．4±11．7）岁。所有患者术中监测迷走反应，并根据监测结果分为迷走阳性组和阴性组。术后根据Hoher和心电图随访房颤复发情况。结果术中监测31例迷走反应阳性（50．8％），30例迷走反应阴性。随访（7．8±2．5）个月，10例房颤复发。其中，迷走阳性组复发率显著低于迷走阴性组（6．4％vs26．7％，P〈0．05）。多因素Cox回归分析提示迷走反应能独立预测冷冻术后房颤复发情况（Wald：4．005，95％CI：0．008—0．951，P=0．045）。结论冷冻术中迷走反应是阵发性房颤患者近中期是否复发的一项预测因子。去迷走神经化可能提高阵发性房颤冷冻消融的成功率。

Objective To investigate the correlation between vagal reaction during cryoablation and the paroxysmal atrial fibrillation（AF） recurrence during follow-up, and aimed to analyze the possible mechanism. Method A total of 61 patients with paroxysmal AF including 38 males and 23 females with age of（58.4± 11.7） were enrolled in the current study. All of patients underwent pulmonary vein isolation with cryoballoon ablation. This population was divided into two groups （ positive and negative vagal reaction groups） based on the recording of the occurrence of intra-procedural vagal reaction. The patients were followed by Holter and ECG. Results During the procedure of cryoablation, positive vagal reaction was observed in 31 patients （50.8%） and negative vagal reaction was observed in 30 patients. At a mean of （7.8±2.5） month follow-up, 10 patients experienced AF recuffence. The AF recurrence in positive vagal reaction group was significantly lower than that in the negative group （6.4% vs 26.7 %, P〈0.05 ）. The muhifactor Cox analysis showed that vagal reaction could individually predict the AF recurrence （ Wald：4. 005,95% CI：0. 008-0. 951 ,P=0. 045 ）. Conclusion Vagal reaction during cryoablation is one of predictors for AF recurrence. The findings of this study indicat that the vagal denervation maybe improve the success rate of PAF cryoablation. [ Chinese Journal of Cardiac Pacing and Electrophysiology, 2015,29（6） ：515-518]