Atrial fibrillation electrical remodelling via ablation of the epicardial neural networks and suprathreshold stimulation of vagosympathetic nerve.
Atrial fibrillation electrical remodelling via ablation of the epicardial neural networks and suprathreshold stimulation of vagosympathetic nerve.
复制标题
通过心外膜神经网络消融和迷走交感神经阈上刺激进行心房颤动电重塑
DOI：
10.12659/msm.892156
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发表时间：
2015-01-07
期刊：
影响因子：
--
通讯作者：
Tang B
中科院分区：
文献类型：
--
作者：
Lu Y;Sun J;Zhou X;Sun Q;Sun S;Tang B
大量研究表明，心脏自主神经系统（CANS）参与心房颤动（AF）的发生和持续。CANS通常被认为由外在和内在自主神经组成。外源性和内源性神经刺激、神经丛消融对肺静脉袖套和心房心肌的影响为理解AF的发生和持续提供了重要信息。迷走交感神经刺激和心外膜神经网络是心房电重构（AER）的重要参与者。阐明心外膜神经网络消融和自主神经刺激引起的心房和肺静脉电生理指标的变化，可能为AF的临床治疗提供理论依据。
共13只比格犬随机分为2组：对照组（n = 6），单纯快速心房起搏（RAP）6小时；实验组（n = 7），RAP + 迷走神经刺激（VNS）6小时。两组均在6小时后进行心外膜神经节丛（GP）消融。我们测量了起搏或消融前后的单相动作电位（MAP）、有效不应期（ERP）各部分以及AF诱发率。
随着起搏时间的延长，两组的心房MAP和ERP缩短，消融神经丛后恢复正常。GP消融后，心房AF诱发率与肺静脉相比无明显下降。
迷走神经阈值刺激加剧了电重构的恶化，而心外膜神经网络消融则阻断或逆转了AER。
Numerous studies have shown that the cardiac autonomic nervous system (CANS) is involved in the occurrence and persistence of atrial fibrillation (AF). The CANS is commonly considered to consist of the extrinsic and intrinsic autonomic nerves. The influence of exogenous and endogenous nerve stimulation plexus ablation on pulmonary vein sleeves and atrial myocardium provides important information in understanding the occurrence and persistence of AF. Vagosympathetic nerve stimulation and epicardial neural networks are important participants in atrial electrical remodelling (AER). Elucidation of the changes in the electrophysiological indicators of the atrial and pulmonary veins caused by epicardial neural network ablation and autonomic nerve stimulation may provide a theoretical basis for the clinical treatment of AF. A total of 13 beagle dogs were randomly divided into 2 groups: the control group (n=6), which was treated with a simple rapid atrial pacing (RAP) for 6 h, and the experimental group (n=7), which was treated with RAP+vagus nerve stimulation (VNS) for 6 h. Both groups were treated with epicardial ganglia plexus (GP) ablation after 6 h. We measured the monophasic action potential (MAP), various parts of the effective refractory period (ERP), and AF induction rate before and after pacing or ablation. With the extension of the pacing time, the atrial MAP and ERP of the 2 groups shortened and returned to normal after ablation plexus. After GP ablation, the atrial AF-induced rate did not decrease significantly compared with that of the pulmonary vein. Vagus nerve threshold stimulation exacerbated the deterioration of electrical remodelling, whereas the epicardial neural network ablation blocked or reversed the AER.