心房颤动的神经机制及治疗研究进展

Research progress of neural mechanisms and therapeutic opportunities for atrial fibrillation

心房颤动(房颤)是临床最常见的心律失常。自主神经系统在房颤的发生及维持中起着重要作用。心脏受内外在自主神经的调节。外在自主神经中的交感神经纤维主要来源于椎旁神经节,特别是星状神经节,星状神经节与胸腔内的多条神经和结构相连,是心脏交感神经支配的最重要来源。心脏内在的自主神经是一个由轴突和神经节丛组成的网络,包含各种交感和副交感神经元,它们与外在自主神经相互影响,共同维持心脏搏动速率及节律。目前通过调节自主神经活性的方法控制房颤的心室率及心脏节律已被广泛研究并逐步应用于临床治疗,常用自主神经调控方法包括皮下神经刺激、心脏神经节丛消融、去交感神经化、刺激迷走神经和星状神经节消融及部分切除等。本文就影响房颤相关神经机制及神经调控方法进展进行综述。

Atrial fibrillation(AF)is the most common arrhythmia in the clinic.Autonomic nervous system plays a significant role in the occurrence and maintenance of AF.The heart is regulated by the internal and external autonomic nerves.The sympathetic nerve fibers of the external autonomic nervous system mainly originate from the paraspinal ganglion,especially the stellate ganglion(SG).SG is the most important source of cardiac sympathetic innervation and is connected with many nerves and structures in the thoracic cavity.The intrinsic autonomic nerve of the heart is a network of axons and ganglions plexus,consisting of various sympathetic and parasympathetic neurons,which interacts with the external autonomic nerve to maintain the heart’s beating rate and rhythm.At present,the methods of controlling the ventricular rate and cardiac rhythm of atrial fibrillation by regulating the autonomic nerve activity have been widely studied and gradually applied in the clinical treatment.The commonly used autonomic nerve regulation methods include subcutaneous nerve stimulation,ganglionated plexi ablation,renal sympathetic denervation,low-level vagal nerve stimulation and stellate ganglion ablation and partial ectomy.In this paper,the neural mechanisms that influence AF and the progress of neuroregulatory approaches are reviewed.