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Electrocardiographic Findings, Arrhythmias, and Left Ventricular Involvement in Familial ST-Depression Syndrome 家族性st段抑郁综合征的心电图表现、心律失常和左心室受累
Pub Date : 2022-03-31 DOI: 10.1161/CIRCEP.121.010688
A. Christensen, C. Vissing, A. Pietersen, J. Tfelt‐Hansen, Thomas Hartvig Lindkær Jensen, S. Pehrson, F. Henriksen, N. Sandgaard, K. Iversen, H. Jensen, M. Olesen, H. Bundgaard
Background: Familial ST-depression syndrome is an inherited disease characterized by persistent, nonischemic ST-deviations, and risk of arrhythmias and heart failure. We aimed at further characterizing the ECG, arrhythmias, and structural characteristics associated with this novel syndrome. Methods: Retrospective analysis of data from consecutive families with familial ST-depression Syndrome in Denmark. ECG features, prevalence and type of arrhythmias, occurrence of systolic dysfunction, and medium-term outcome were analyzed. Results: Forty affected individuals (43% men; mean age at diagnosis 49.1 years) from 14 apparently unrelated families with ≥2 affected members were included. Autosomal dominant inheritance was observed in all families. The ECG phenotype seemed to develop in prepuberty and the ST-deviations were persistent and most pronounced in leads V4/V5/II, respectively. Serial ECG analyses showed stable to slow progression of the ECG phenotype. Exercise accentuated the ST-deviations with a maximum difference between rest/stress (mean) of −117 μV in lead V5. During a mean follow-up of 9.3±7.1 years 5 (13%) patients developed sustained ventricular arrhythmias or (aborted) sudden cardiac death, 10 (25%) developed atrial fibrillation, 2 (5%) other supraventricular arrhythmias, and 10 (25%) were diagnosed with left ventricular ejection fraction ≤50%. The ventricular arrhythmias were polymorphic with relatively short-coupled premature ventricular contractions at onset (300–360 ms); no QT prolongation was observed. Seven patients had at least one catheter ablation; 5 for supraventricular arrhythmias and 2 for ventricular arrhythmias. Males experienced more arrhythmic end points than females (P<0.01). Conclusions: The familial ST-depression ECG phenotype is stable to slowly progressive after medium-term follow-up. Clinically, both supra- and ventricular arrhythmias are common; as are some degree of left ventricular systolic dysfunction. Familial ST-depression represent a novel inherited cause of polymorphic ventricular tachycardia.
背景:家族性st段抑制综合征是一种以持续、非缺血性st段偏离、心律失常和心力衰竭风险为特征的遗传性疾病。我们的目的是进一步表征ECG、心律失常和与这种新综合征相关的结构特征。方法:回顾性分析丹麦家族性st -抑郁综合征连续家庭的资料。分析心电图特征、心律失常的发生率和类型、收缩功能障碍的发生情况及中期预后。结果:40例患者(43%为男性;诊断时平均年龄49.1岁,来自14个明显不相关且患者≥2人的家庭。所有家族均存在常染色体显性遗传。心电图表型似乎是在青春期前形成的,st段偏离分别在V4/V5/II导联中持续且最明显。连续心电图分析显示,心电图表型的进展稳定到缓慢。运动加重了导联V5的st差,休息/应激差(平均值)最大为- 117 μV。在平均9.3±7.1年的随访期间,5例(13%)患者发生持续性室性心律失常或(流产)心源性猝死,10例(25%)发生房颤,2例(5%)发生其他室上性心律失常,10例(25%)被诊断为左心室射血分数≤50%。室性心律失常具有多态性,发病时(300-360 ms)伴有相对短时间耦合的室性早搏;未见QT延长。7例患者至少有一次导管消融;室上性心律失常5次,室性心律失常2次。男性出现的心律失常终点多于女性(P<0.01)。结论:经中期随访,家族性st段抑郁的心电图表型稳定到缓慢进展。临床上,上室性心律失常和室性心律失常都很常见;还有一定程度的左心室收缩功能障碍。家族性st段抑制是多形性室性心动过速的一种新的遗传原因。
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引用次数: 5
Trends and Outcomes of Catheter Ablation of Ventricular Tachycardia in Patients With Ischemic and Nonischemic Cardiomyopathy. 缺血性和非缺血性心肌病患者室性心动过速导管消融的趋势和结果。
Pub Date : 2022-03-28 DOI: 10.1161/CIRCEP.121.010742
C. Sciria, Edward V. Kogan, J. Ip, G. Thomas, CHRISTOPHER F. Liu, S. Markowitz, B. Lerman, L. Kim, Jim W. Cheung
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引用次数: 3
Magnetic Field Measurements of Portable Electronic Devices: The Risk Inside Pockets for Patients With Cardiovascular Implantable Devices. 便携式电子设备的磁场测量:心血管植入设备患者口袋内的风险。
Pub Date : 2022-03-01 DOI: 10.1161/CIRCEP.121.010646
C. Féry, Adrien Desombre, T. Quirin, P. Badertscher, C. Sticherling, S. Knecht, J. Pascal
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引用次数: 5
Correction to: Gagyi et al, New Possibilities in the Treatment of Brief Episodes of Highly Symptomatic Atrial Tachycardia: The Usefulness of Single-Position Single-Beat Charge Density Mapping. 修正:Gagyi等人,治疗短暂性高症状性房性心动过速的新可能性:单位置单拍电荷密度制图的实用性。
Pub Date : 2022-03-01 DOI: 10.1161/HAE.0000000000000083
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引用次数: 0
Novel CALM3 Variant Causing Calmodulinopathy With Variable Expressivity in a 4-Generation Family 在一个4代家族中引起钙调蛋白病的新CALM3变异具有可变表达性
Pub Date : 2022-02-28 DOI: 10.1161/CIRCEP.121.010572
K. Kato, Holly M. Isbell, V. Fressart, I. Denjoy, A. Debbiche, H. Itoh, J. Poinsot, Alfred L. George, A. Coulombe, M. A. Shea, P. Guicheney
Background: CaM (calmodulin), encoded by 3 separate genes (CALM1, CALM2, and CALM3), is a multifunctional Ca2+-binding protein involved in many signal transduction events including ion channel regulation. CaM variants may present with early-onset long QT syndrome (LQTS), catecholaminergic polymorphic ventricular tachycardia, or sudden cardiac death. Most reported variants occurred de novo. We identified a novel CALM3 variant, p.Asn138Lys (N138K), in a 4-generation family segregating with LQTS. The aim of this study was to elucidate its pathogenicity and to compare it with that of p.D130G-CaM—a variant associated with a severe LQTS phenotype. Methods: We performed whole exome sequencing for a large, 4-generation family affected by LQTS. To assess the effect of the detected CALM3 variant, the intrinsic Ca2+-binding affinity was measured by stoichiometric Ca2+ titrations and equilibrium titrations. L-type Ca2+ and slow delayed rectifier potassium currents (ICaL and IKs) were recorded by whole-cell patch-clamp. Cav1.2 and Kv7.1 membrane expression were determined by optical fluorescence assays. Results: We identified 14 p.N138K-CaM carriers in a family where 2 sudden deaths occurred in children. Several members were only mildly affected compared with CaM-LQTS patients to date described in literature. The intrinsic Ca2+-binding affinity of the CaM C-terminal domain was 10-fold lower for p.N138K-CaM compared with wild-type-CaM. ICaL inactivation was slowed in cells expressing p.N138K-CaM but less than in p.D130G-CaM cells. Unexpectedly, a larger IKs current density was observed in cells expressing p.N138K-CaM, but not for p.D130G-CaM, compared with wild-type-CaM. Conclusions: The p.N138K CALM3 variant impairs Ca2+-binding affinity of CaM and ICaL inactivation but potentiates IKs. The variably expressed phenotype of this variant compared with previously published de novo LQTS-CaM variants is likely explained by a milder impairment of ICaL inactivation combined with IKs augmentation.
背景:CaM (calmodulin)是一种多功能Ca2+结合蛋白,由3个独立的基因(CALM1、CALM2和CALM3)编码,参与包括离子通道调节在内的许多信号转导事件。CaM变异可能表现为早发性长QT综合征(LQTS)、儿茶酚胺能多形性室性心动过速或心源性猝死。大多数报告的变异都是从头发生的。我们在一个与LQTS分离的4代家族中发现了一种新的CALM3变体p.Asn138Lys (N138K)。本研究的目的是阐明其致病性,并将其与p.d 130g - cam(一种与严重LQTS表型相关的变异)的致病性进行比较。方法:我们对一个受LQTS影响的4代大家庭进行了全外显子组测序。为了评估检测到的CALM3变异的影响,通过化学计量Ca2+滴定和平衡滴定来测量固有的Ca2+结合亲和力。全细胞膜片钳记录l型Ca2+和慢延迟整流钾电流(ICaL和IKs)。光学荧光法检测Cav1.2和Kv7.1膜表达。结果:我们在一个发生2例儿童猝死的家庭中鉴定出14例p.N138K-CaM携带者。与迄今文献中描述的CaM-LQTS患者相比,一些成员仅轻度受影响。与野生型CaM相比,p.N138K-CaM的c端结构域的内在Ca2+结合亲和力降低了10倍。表达p.N138K-CaM的细胞的ICaL失活减慢,但低于p.D130G-CaM细胞。出乎意料的是,与野生型cam相比,在表达p.N138K-CaM的细胞中观察到更大的ik电流密度,而在表达p.D130G-CaM的细胞中则没有。结论:p.N138K CALM3变异体损害CaM和ICaL的Ca2+结合亲和力,但增强IKs。与先前发表的新生LQTS-CaM变体相比,该变体的可变表达表型可能是由于ICaL失活和IKs增强的轻微损伤。
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引用次数: 10
Circulation: Arrhythmia and Electrophysiology Editors and Editorial Board. 循环:心律失常和电生理学编辑和编辑委员会。
Pub Date : 2021-01-01 DOI: 10.1161/HAE.0000000000000074
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引用次数: 0
Circulation: Arrhythmia and Electrophysiology Editors and Editorial Board. 循环:心律失常和电生理学编辑和编辑委员会。
Pub Date : 2020-01-01 DOI: 10.1161/hae.0000000000000046
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引用次数: 0
Renewal Theory as a Universal Quantitative Framework to Characterize Phase Singularity Regeneration in Mammalian Cardiac Fibrillation. 更新理论是表征哺乳动物心脏颤相奇异再生的通用定量框架。
Pub Date : 2019-12-01 DOI: 10.1161/CIRCEP.119.007569
D. Dharmaprani, M. Schopp, P. Kuklik, D. Chapman, A. Lahiri, L. Dykes, F. Xiong, M. Aguilar, B. Strauss, L. Mitchell, K. Pope, C. Meyer, S. Willems, F. Akar, S. Nattel, A. McGavigan, A. Ganesan
BACKGROUNDDespite a century of research, no clear quantitative framework exists to model the fundamental processes responsible for the continuous formation and destruction of phase singularities (PS) in cardiac fibrillation. We hypothesized PS formation/destruction in fibrillation could be modeled as self-regenerating Poisson renewal processes, producing exponential distributions of interevent times governed by constant rate parameters defined by the prevailing properties of each system.METHODSPS formation/destruction were studied in 5 systems: (1) human persistent atrial fibrillation (n=20), (2) tachypaced sheep atrial fibrillation (n=5), (3) rat atrial fibrillation (n=4), (5) rat ventricular fibrillation (n=11), and (5) computer-simulated fibrillation. PS time-to-event data were fitted by exponential probability distribution functions computed using maximum entropy theory, and rates of PS formation and destruction (λf/λd) determined. A systematic review was conducted to cross-validate with source data from literature.RESULTSIn all systems, PS lifetime and interformation times were consistent with underlying Poisson renewal processes (human: λf, 4.2%/ms±1.1 [95% CI, 4.0-5.0], λd, 4.6%/ms±1.5 [95% CI, 4.3-4.9]; sheep: λf, 4.4%/ms [95% CI, 4.1-4.7], λd, 4.6%/ms±1.4 [95% CI, 4.3-4.8]; rat atrial fibrillation: λf, 33%/ms±8.8 [95% CI, 11-55], λd, 38%/ms [95% CI, 22-55]; rat ventricular fibrillation: λf, 38%/ms±24 [95% CI, 22-55], λf, 46%/ms±21 [95% CI, 31-60]; simulated fibrillation λd, 6.6-8.97%/ms [95% CI, 4.1-6.7]; R2≥0.90 in all cases). All PS distributions identified through systematic review were also consistent with an underlying Poisson renewal process.CONCLUSIONSPoisson renewal theory provides an evolutionarily preserved universal framework to quantify formation and destruction of rotational events in cardiac fibrillation.
尽管经过了一个世纪的研究,但没有明确的定量框架来模拟心脏颤动中相奇点(PS)连续形成和破坏的基本过程。我们假设纤颤中PS的形成/破坏可以建模为自再生泊松更新过程,产生由每个系统的主要特性定义的恒定速率参数控制的事件间时间的指数分布。方法对5种系统sps的形成/破坏进行研究:(1)人持续性心房颤动(n=20),(2)速搏羊心房颤动(n=5),(3)大鼠心房颤动(n=4),(5)大鼠心室颤动(n=11),(5)计算机模拟心房颤动。利用最大熵理论计算的指数概率分布函数拟合PS的时间-事件数据,确定PS的形成和破坏速率(λf/λd)。系统回顾与文献源数据进行交叉验证。结果在所有系统中,PS寿命和信息传递时间与潜在的泊松更新过程一致(人类:λf, 4.2%/ms±1.1 [95% CI, 4.0 ~ 5.0], λd, 4.6%/ms±1.5 [95% CI, 4.3 ~ 4.9];羊:λf, 4.4% (95% CI, 4.1 - -4.7),女士/λd, 4.6% /女士±1.4 (95% CI, 4.3 - -4.8);大鼠心房颤动:λf, 33%/ms±8.8 [95% CI, 11-55], λd, 38%/ms [95% CI, 22-55];大鼠心室颤动:λf, 38%/ms±24 [95% CI, 22-55], λf, 46%/ms±21 [95% CI, 31-60];模拟纤颤λd, 6.6-8.97%/ms [95% CI, 4.1-6.7];所有病例R2≥0.90)。通过系统评价确定的所有PS分布也符合潜在的泊松更新过程。结论波松更新理论提供了一个进化上保存的通用框架来量化心房纤颤旋转事件的形成和破坏。
{"title":"Renewal Theory as a Universal Quantitative Framework to Characterize Phase Singularity Regeneration in Mammalian Cardiac Fibrillation.","authors":"D. Dharmaprani, M. Schopp, P. Kuklik, D. Chapman, A. Lahiri, L. Dykes, F. Xiong, M. Aguilar, B. Strauss, L. Mitchell, K. Pope, C. Meyer, S. Willems, F. Akar, S. Nattel, A. McGavigan, A. Ganesan","doi":"10.1161/CIRCEP.119.007569","DOIUrl":"https://doi.org/10.1161/CIRCEP.119.007569","url":null,"abstract":"BACKGROUND\u0000Despite a century of research, no clear quantitative framework exists to model the fundamental processes responsible for the continuous formation and destruction of phase singularities (PS) in cardiac fibrillation. We hypothesized PS formation/destruction in fibrillation could be modeled as self-regenerating Poisson renewal processes, producing exponential distributions of interevent times governed by constant rate parameters defined by the prevailing properties of each system.\u0000\u0000\u0000METHODS\u0000PS formation/destruction were studied in 5 systems: (1) human persistent atrial fibrillation (n=20), (2) tachypaced sheep atrial fibrillation (n=5), (3) rat atrial fibrillation (n=4), (5) rat ventricular fibrillation (n=11), and (5) computer-simulated fibrillation. PS time-to-event data were fitted by exponential probability distribution functions computed using maximum entropy theory, and rates of PS formation and destruction (λf/λd) determined. A systematic review was conducted to cross-validate with source data from literature.\u0000\u0000\u0000RESULTS\u0000In all systems, PS lifetime and interformation times were consistent with underlying Poisson renewal processes (human: λf, 4.2%/ms±1.1 [95% CI, 4.0-5.0], λd, 4.6%/ms±1.5 [95% CI, 4.3-4.9]; sheep: λf, 4.4%/ms [95% CI, 4.1-4.7], λd, 4.6%/ms±1.4 [95% CI, 4.3-4.8]; rat atrial fibrillation: λf, 33%/ms±8.8 [95% CI, 11-55], λd, 38%/ms [95% CI, 22-55]; rat ventricular fibrillation: λf, 38%/ms±24 [95% CI, 22-55], λf, 46%/ms±21 [95% CI, 31-60]; simulated fibrillation λd, 6.6-8.97%/ms [95% CI, 4.1-6.7]; R2≥0.90 in all cases). All PS distributions identified through systematic review were also consistent with an underlying Poisson renewal process.\u0000\u0000\u0000CONCLUSIONS\u0000Poisson renewal theory provides an evolutionarily preserved universal framework to quantify formation and destruction of rotational events in cardiac fibrillation.","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":"7 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79614306","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 26
Catheter Ablation Versus Best Medical Therapy in Patients With Persistent Atrial Fibrillation and Congestive Heart Failure: The Randomized AMICA Trial. 持续性心房颤动和充血性心力衰竭患者的导管消融与最佳药物治疗:随机AMICA试验
Pub Date : 2019-11-25 DOI: 10.1161/CIRCEP.119.007731
K. Kuck, B. Merkely, R. Zahn, T. Arentz, K. Seidl, M. Schlüter, R. Tilz, C. Piorkowski, L. Gellér, T. Kleemann, G. Hindricks
BACKGROUNDOptimal treatment of patients with persistent atrial fibrillation (AF) and heart failure (HF) with reduced left ventricular ejection fraction (LVEF) and an indication for internal defibrillator therapy is controversial.METHODSPatients with persistent/longstanding persistent AF and LVEF ≤35% were randomly allocated to catheter ablation of AF or best medical therapy (BMT). The primary study end point was the absolute increase in LVEF from baseline at 1 year. Secondary end points included 6-minute walk test, quality-of-life, and NT-proBNP (N-terminal pro-brain natriuretic peptide). Pulmonary vein isolation was the primary ablation approach; BMT comprised rate or rhythm control. All patients were discharged after index hospitalization with a cardioverter-defibrillator or cardiac resynchronization therapy defibrillator implanted. The study was terminated early for futility.RESULTSOf 140 patients (65±8 years, 126 [90%] men) available for the end point analysis, 68 and 72 patients were assigned to ablation and BMT, respectively. At 1 year, LVEF had increased in ablation patients by 8.8% (95% CI, 5.8%-11.9%) and in BMT patients by 7.3% (4.3%-10.3%; P=0.36). Sinus rhythm was recorded on 12-lead electrocardiograms at 1 year in 61/83 ablation patients (73.5%) and 42/84 BMT patients (50%). Device-recorded AF burden at 1 year was 0% or maximally 5% of the time in 28/39 ablation patients (72%) and 16/36 BMT patients (44%). There was no difference in secondary end point outcome between ablation patients and BMT patients.CONCLUSIONSThe AMICA trial (Atrial Fibrillation Management in Congestive Heart Failure With Ablation) did not reveal any benefit of catheter ablation in patients with AF and advanced HF. This was mainly because of the fact that at 1 year, LVEF increased in ablation patients to a similar extent as in BMT patients. The effect of catheter ablation of AF in patients with HF may be affected by the extent of HF at baseline, with a rather limited ablation benefit in patients with seriously advanced HF.CLINICAL TRIAL REGISTRATIONURL: https://www.clinicaltrials.gov. Unique identifier: NCT00652522.
背景:持续性心房颤动(AF)和心力衰竭(HF)患者左心室射血分数(LVEF)降低的最佳治疗方法和内部除颤器治疗的适应症存在争议。方法将LVEF≤35%的持续性/长期持续性房颤患者随机分配到房颤导管消融组或最佳药物治疗组(BMT)。主要研究终点是1年时LVEF从基线的绝对增加。次要终点包括6分钟步行测试、生活质量和NT-proBNP (n端脑利钠肽前体)。肺静脉隔离是主要的消融途径;BMT包括速率或节奏控制。所有患者在植入心律转复除颤器或心脏再同步化治疗除颤器后住院后出院。这项研究因无效而提前终止了。结果140例患者(65±8岁,126例[90%]男性)可用于终点分析,68例和72例患者分别被分配到消融术和BMT。1年时,消融患者的LVEF增加了8.8% (95% CI, 5.8%-11.9%), BMT患者的LVEF增加了7.3% (4.3%-10.3%;P = 0.36)。61/83例消融患者(73.5%)和42/84例BMT患者(50%)在1年12导联心电图上记录窦性心律。在28/39例消融患者(72%)和16/36例BMT患者(44%)中,设备记录的1年房颤负担为0%或最多5%。消融患者和BMT患者的次要终点结局无差异。结论AMICA试验(充血性心力衰竭伴消融的心房颤动管理)未显示导管消融对房颤和晚期心衰患者有任何益处。这主要是因为在1年时,消融患者的LVEF增加的程度与BMT患者相似。心衰患者房颤导管消融的效果可能受到基线时心衰程度的影响,严重晚期心衰患者的消融获益相当有限。临床试验注册网址:https://www.clinicaltrials.gov。唯一标识符:NCT00652522。
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引用次数: 108
Avoidance of Vagal Response During Circumferential Pulmonary Vein Isolation: Effect of Initiating Isolation From Right Anterior Ganglionated Plexi. 环形肺静脉隔离时迷走神经反应的避免:从右前神经节丛开始隔离的效果。
Pub Date : 2019-11-25 DOI: 10.1161/CIRCEP.119.007811
Feng Hu, Lihui Zheng, Shangyu Liu, Lishui Shen, E. Liang, L. Ding, Ling-min Wu, Gang Chen, Xiaohan Fan, Yan Yao
BACKGROUNDCircumferential pulmonary vein isolation (CPVI) often cause unavoidable vagal reflexes during procedure due to the coincidental modification of ganglionated plexus which are located on pulmonary vein (PV) antrum. The right anterior ganglionated plexi (RAGP) which located at superoanterior area of right superior PV antrum is an essential station to regulate the cardiac autonomic nerve activities and is easily coincidentally ablated during CPVI. The aim of this study is to assess the effect of RAGP ablation on vagal response (VR) during CPVI.METHODSA total of 80 patients with paroxysmal atrial fibrillation who underwent the first time CPVI were prospectively enrolled and randomly assigned to 2 groups: group A (n=40), CPVI started with right PVs at RAGP site; group B (n=40): CPVI started with left PVs first, and the last ablation site is RAGP. Electrophysiological parameters include basal cycle length, A-H interval, H-V interval, sinus node recovery time, and atrioventricular node Wenckebach point were recorded before and after CPVI procedure.RESULTSDuring CPVI, the positive VR were only observed on 1 patient in group A and 25 patients in group B (P<0.001). A total of 21 patients with positive VR in group B needed for temporary ventricular pacing during procedure, while the only patient with positive VR in group A did not need for temporary ventricular pacing (P<0.001). Compared with baseline, basal cycle length, sinus node recovery time, and atrioventricular node Wenckebach point were decreased significantly after CPVI procedure in both groups (all P<0.05) and without differences between 2 groups.CONCLUSIONSCircumferential PV isolation initiated from RAGP could effectively inhibit VR occurrence and significantly increase heart rate during procedure.
背景环肺静脉隔离术(CPVI)在手术过程中,由于对位于肺静脉(PV)上腔的神经节丛的改变,常常引起不可避免的迷走神经反射。右前神经节丛(RAGP)位于右PV上腔上前区,是调节心脏自主神经活动的重要部位,在CPVI过程中容易发生巧合消融。本研究的目的是评估RAGP消融对CPVI期间迷走神经反应(VR)的影响。方法前瞻性纳入80例首次行CPVI的阵发性心房颤动患者,随机分为2组:A组(n=40), CPVI开始于RAGP部位右侧pv;B组(n=40): CPVI首先以左侧pv开始,最后消融部位为RAGP。记录CPVI手术前后的基础周期长度、A-H间期、H-V间期、窦房结恢复时间、房室结Wenckebach点等电生理参数。结果在CPVI过程中,A组只有1例患者出现VR阳性,B组只有25例患者出现VR阳性(P<0.001)。B组共有21例VR阳性患者术中需要临时心室起搏,而A组仅有1例VR阳性患者术中不需要临时心室起搏(P<0.001)。与基线比较,两组CPVI术后基础周期长度、窦房结恢复时间、房室结Wenckebach点均显著缩短(均P<0.05),两组间差异无统计学意义。结论RAGP诱导的PV环向分离可有效抑制VR的发生,并显著提高术中心率。
{"title":"Avoidance of Vagal Response During Circumferential Pulmonary Vein Isolation: Effect of Initiating Isolation From Right Anterior Ganglionated Plexi.","authors":"Feng Hu, Lihui Zheng, Shangyu Liu, Lishui Shen, E. Liang, L. Ding, Ling-min Wu, Gang Chen, Xiaohan Fan, Yan Yao","doi":"10.1161/CIRCEP.119.007811","DOIUrl":"https://doi.org/10.1161/CIRCEP.119.007811","url":null,"abstract":"BACKGROUND\u0000Circumferential pulmonary vein isolation (CPVI) often cause unavoidable vagal reflexes during procedure due to the coincidental modification of ganglionated plexus which are located on pulmonary vein (PV) antrum. The right anterior ganglionated plexi (RAGP) which located at superoanterior area of right superior PV antrum is an essential station to regulate the cardiac autonomic nerve activities and is easily coincidentally ablated during CPVI. The aim of this study is to assess the effect of RAGP ablation on vagal response (VR) during CPVI.\u0000\u0000\u0000METHODS\u0000A total of 80 patients with paroxysmal atrial fibrillation who underwent the first time CPVI were prospectively enrolled and randomly assigned to 2 groups: group A (n=40), CPVI started with right PVs at RAGP site; group B (n=40): CPVI started with left PVs first, and the last ablation site is RAGP. Electrophysiological parameters include basal cycle length, A-H interval, H-V interval, sinus node recovery time, and atrioventricular node Wenckebach point were recorded before and after CPVI procedure.\u0000\u0000\u0000RESULTS\u0000During CPVI, the positive VR were only observed on 1 patient in group A and 25 patients in group B (P<0.001). A total of 21 patients with positive VR in group B needed for temporary ventricular pacing during procedure, while the only patient with positive VR in group A did not need for temporary ventricular pacing (P<0.001). Compared with baseline, basal cycle length, sinus node recovery time, and atrioventricular node Wenckebach point were decreased significantly after CPVI procedure in both groups (all P<0.05) and without differences between 2 groups.\u0000\u0000\u0000CONCLUSIONS\u0000Circumferential PV isolation initiated from RAGP could effectively inhibit VR occurrence and significantly increase heart rate during procedure.","PeriodicalId":10167,"journal":{"name":"Circulation: Arrhythmia and Electrophysiology","volume":"14 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2019-11-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72976254","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 12
期刊
Circulation: Arrhythmia and Electrophysiology
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