Selective atrial vagal denervation guided by evoked vagal reflex to treat patients with paroxysmal atrial fibrillation
Selective atrial vagal denervation guided by evoked vagal reflex to treat patients with paroxysmal atrial fibrillation
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DOI：
10.1161/circulationaha.106.633560
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发表时间：
2006-08-29
期刊：
影响因子：
37.8
通讯作者：
Sosa, Eduardo
中科院分区：
文献类型：
--
作者：
Scanavacca, Mauricio;Pisani, Cristiano F.;Sosa, Eduardo
背景-本研究的目的是评估选择性射频（RF）导管消融高频刺激诱导迷走神经反射的心房部位是否能预防阵发性心房颤动（AF）。方法和结果-选择10例有迷走神经诱导阵发性AF发作提示且无心脏病的患者进行经皮心房心外膜和心内膜标测，以寻找高频刺激诱导迷走神经反射的心房部位。频率经导管刺激（20 Hz）诱导迷走神经反射。在10名患者中的7名（70%）中引发了迷走神经反应，定义为AV阻滞> 2秒，每名患者平均5 +/- 2.4（范围，2至9）个部位，并在这些部位施加RF脉冲（每名患者21.0 +/- 12.0）以消除所有诱发的迷走神经反射。未获得诱发迷走神经反射的3例患者接受了环肺静脉消融，平均每例患者58.0 +/- 13.9次射频脉冲（P = 0.022）。自主神经评估进行了术前和术后48小时和3个月，是一致的迷走神经撤回所有患者。在平均随访8.3 +/- 2.8个月（范围，5 - 15个月）时，接受去神经支配的7例患者中有2例在未使用抗心律失常药物的情况下保持无症状; 4例频繁复发，并被转诊接受环肺静脉消融术; 1例在未使用抗心律失常药物的情况下很少发生AF发作。3例无诱发性迷走反射的患者接受了环肺静脉消融术，但在未使用抗心律失常药物的情况下仍无症状。一名患者有急性胃排空延迟后心房迷走神经denervation. Conclusions射频导管消融选定的心房网站中，高频刺激引起的迷走神经反射可能会防止房颤复发明显迷走神经引起的阵发性房颤患者。
Background-The aim of this study was to evaluate whether selective radiofrequency (RF) catheter ablation of the atrial sites in which high-frequency stimulation induces vagal reflexes prevents paroxysmal atrial fibrillation (AF).Methods and Results-Ten patients with episodes suggestive of vagal-induced paroxysmal AF and no heart disease were selected for percutaneous epicardial and endocardial mapping of the atria to search for sites in which high-frequency transcatheter stimulation (20 Hz,) induced vagal reflexes. A vagal response defined as AV block of > 2 seconds was elicited in 7 of 10 patients (70%) with an average of 5 +/- 2.4 (range, 2 to 9) sites per patient, and RF pulses (21.0 +/- 12.0 per patient) were applied at those sites to eliminate all evoked vagal reflexes. The 3 patients in whom evoked vagal reflexes were not obtained underwent circumferential pulmonary vein ablation with an average of 58.0 +/- 13.9 RF pulses per patient (P = 0.022). Autonomic evaluation was performed before and 48 hours and 3 months after the procedure and was consistent with vagal withdrawal in all patients. Two of the 7 patients who underwent denervation remained asymptomatic without the use of antiarrhythmic medication at a mean follow-up of 8.3 +/- 2.8 months (range, 5 to 15 months); 4 had frequent recurrences and were referred for circumferential pulmonary vein ablation; and 1 had few AF episodes without antiarrhythmic medication. The 3 patients without evoked vagal reflexes who underwent circumferential pulmonary vein ablation remained asymptomatic without antiarrhythmic medication. One patient had acute delayed gastric emptying after atrial vagal denervation.Conclusions-RF catheter ablation of selected atrial sites in which high-frequency stimulation induced vagal reflexes may prevent AF recurrences in selected patients with apparently vagal-induced paroxysmal AF.