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。

Feng Hu, Lihui Zheng, Shangyu Liu, Lishui Shen, E. Liang, L. Ding, Ling-min Wu, Gang Chen, Xiaohan Fan, Yan Yao
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引用次数: 12

摘要

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。
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Avoidance of Vagal Response During Circumferential Pulmonary Vein Isolation: Effect of Initiating Isolation From Right Anterior Ganglionated Plexi.
BACKGROUND Circumferential 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. METHODS A 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. RESULTS During 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. CONCLUSIONS Circumferential PV isolation initiated from RAGP could effectively inhibit VR occurrence and significantly increase heart rate during procedure.
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