心脏神经节丛消融治疗心脏抑制型颈动脉窦综合征的观察

Observation of cardiac ganglion plexus ablation in the treatment of cardiac inhibited carotid sinus syndrome

目的 探讨心脏神经节丛(GPs)消融治疗对心脏抑制型颈动脉窦综合征(CSS)的疗效性和安全性。方法 连续纳入20例心脏抑制型CSS患者,男性14例(70%),年龄(61±10)岁。20例均采用CARTO三维标测系统重建左房模型,于左房的≥2个GPs区域消融,观察消融术中出现心率下降、窦性心动过缓或窦性停搏、交界性逸搏等迷走反应情况,消融终点为重复颈动脉窦按摩试验转阴性。术后定期随访,记录晕厥、晕厥前兆、检查动态心电图、重复颈动脉按摩检查等。结果 18例在消融左上GP时出现明显迷走反应,2例在消融左上GP时无明显的迷走反应,仅在消融右前GP时表现为心率加快,所有患者均达到消融终点。随访(15±4)个月,20例均未发生晕厥,有4例发作晕厥前兆,但较术前明显减轻。所有患者均无严重并发症发生。结论 GPs消融治疗心脏抑制型CSS具有较高的安全性和有效性。

Objective To investigate the efficacy and safety of cardiac ganglionic plexus(GPS) ablation in the treatment of cardiac inhibited carotid sinus syndrome(CSS). Methods Twenty patients with cardiac inhibited CSS were enrolled, including 14 males(70%) with an average age of(61±10) years old.Carto three-dimensional mapping system was used to reconstruct the left atrium model in these 20 patients. More than 2 GPs in the anatomical distribution of left atrium model were ablated, and the vagus reactions such as heart rate drop, sinus bradycardia or sinus arrest, and junction escape were observed during ablation. The end point of ablation was negative for repeated carotid sinus massage test.Postoperative follow-up was performed regularly, including syncope, presyncope, dynamic electrocardiogram, repeated carotid artery massage, etc. Results Eighteen patients showed obvious vagal response to the ablation of the left upper GP, and 2 patients showed no obvious vagal response, only but rapid heart rate during the ablation of the right anterior GP. All patients reached the end point of ablation.No syncope occurred in 20 patients during the follow-up(15±4)months period, and only 4 patients had presyncope, but these were significantly better compared with preoperation.No serious complications occurred in all patients. Conclusion GPs ablation is safe and effective in the treatment of cardiac inhibited CSS.