选择性消融Marshall韧带减少缺血再灌注损伤诱导的室性心律失常

Selective ablation of the ligament of Marshall reduces ventricular arrhythmias induced by ischemia/reperfusion injury

目的研究选择性消融Marshall韧带(LOM)对缺血再灌注(I/R)损伤诱导的室性心律失常的影响。方法33只杂种犬随机分为缺血再灌注组(I/R组)(n=11),LOM远段消融+I/R组(LOM组,n=9),左侧星状神经节消融+I/R组(LSG组,n=13)。I/R组结扎左冠状动脉前降支(LAD)缺血30min和再灌注2h完成心肌I/R损伤模型。LOM组与LSG组进行LOM或LSG消融后30 min,同I/R组缺血30 min再灌注2h。分别记录LOM组与LSG组开胸后基础状态以及结扎前消融后30 min的心率变异性[(HRV,包括低频(LF)、高频(HF)、LF/HF值],三组行持续心电图记录,观察各组室性心律失常发生情况。分别于开胸后基础状态、结扎前以及消融LOM或LSG后30min、再灌注2h后经颈内静脉取血,采用ELISA法检测血清去甲肾上腺素(NE)、肾上腺素(E)。结果与开胸后基础状态相比,LOM组与LSG组消融后LF值和LF/HF值明显降低(P<0.05),对HF值的提高无显著性差异。LOM组及LSG组,缺血30min再灌注2h内室性心动过速的发作次数、持续时间明显低于I/R组(P均<0.05),心室颤动的发生有降低趋势。与LOM组相比,LSG组对室性心动过速的发生次数及持续时间也有降低趋势。与同组基础状态比较,I/R组再灌注2h后NE、E增加,LOM组与LSG组则无差异。与I/R组比较,LOM组或LSG组再灌注2h后血清NE、E的水平升高被显著减弱(P<0.05),而LOM组与LSG组无显著性差异。结论消融LOM或LSG均可以降低I/R损伤后室性心律失常的发生,其机制可能与抑制交感神经活性有关。

Objective To investigate the effect of selective ablation of Marshall ligaments（LOM）on ventricular arrhythmias induced by ischemia/reperfusion（I/R）injury.Methods Thirty-three male hybrid canines were randomly divided into the I/R group（n=11）,LOMLSPVdenervation＋I/R group（LOM group,n=9）and LSG Denervation ＋I/R group（LSG group,n=13）.Myocardial I/R injury model was established by ligaturing the left anterior descending artery for 30 min followed reperfusion for 2 h.The dogs underwent LOMLSPVor LSG ablation before LAD occlusion in the two ablation groups.The heart rate variability（HRV,including the ratio of low frequency,the ratio of high frequency and LF/HF）after ligation of the left anterior descending artery 30 min and the occurrence of ventricular arrhythmias during I/R were recorded for 30 min in each group.Internal jugular venous blood were collected respectively after thoracotomy at baseline,before ligation of the left anterior descending coronary after ablation LOM or LSG 30 min,and 2 hafter reperfusion,and serum norepinephrine（NE）and epinephrine（E）were tested by ELISA.Results Compared with the baseline state after thoracotomy,ablation of LOMLSPVor LSG significantly reduced LF and LF/HF values（P〈0.05）,and there was no significant difference in HF value.After 2 hI/R,compared with I/R group,ablation of LOMLSPVor LSG group significantly decreased the serum levels of NE and E（P〈0.05）,and there was no significant difference between ablation groups.In addition,in LOM group and LSG group,the occurrence and duration of ventricular tachycardia（VT）was significantly lower than that in I/R group,and the incidence of ventricular fibrillation（VF）decreased in LOM group and LSG group（P 0.05）.Compared with the LOMLSPVD ＋ I/R group,the LSGD＋I/R group showed a decreasing trend of the occurrence and duration of VT.Conclusion Ablation of LOMLSPV or LSG can similarly reduce the incidence of ventricular arrhythmia post-ischemia/reperfusion injury,and its mechanism may be related to the inhibition of sympathetic activity.