Effects of Renal Denervation via Renal Artery Adventitial Cryoablation on Atrial Fibrillation and Cardiac Neural Remodeling
Effects of Renal Denervation via Renal Artery Adventitial Cryoablation on Atrial Fibrillation and Cardiac Neural Remodeling
复制标题
肾动脉外膜冷冻消融去肾神经对心房颤动和心脏神经重塑的影响
DOI：
10.1155/2018/2603025
复制
发表时间：
2018-01-01
影响因子：
2.1
通讯作者：
Mei, Ju
中科院分区：
文献类型：
--
作者：
Wang, Wei;Jiang, Zhaolei;Mei, Ju
简介 导管肾去神经术（RDN）可以减少心脏交感神经活动（SNA）并抑制心房颤动（AF）。但其可靠性并不确定，因为肾交感神经主要分布在肾动脉外膜表面。目的 本研究的目的是验证肾动脉外膜消融术（RAAA）确实具有 RDN 作用的假设，并研究肾动脉外膜冷冻消融术（RAAC）中的 RDN 对 AF 和心脏神经重塑的影响。方法将20只beagle犬随机分为两组：左RDN组（LRDN，n=10），通过RAAC进行左RDN；假手术组（n=10）。术后恢复2个月后，对两组患者进行AF易损性、AF持续时间及组织学检查。结果与Sham组相比，LRDN组左星状神经节（LSG）组织纤维化程度加重。 LRDN 显着增加了 LSG 中 TH 阴性神经节细胞的百分比，并降低了 TH 阳性神经的密度（P < 0.001）。此外，LRDN 组左心房 (LA) 内 TH 阳性神经的密度和 GAP43 免疫反应性显着降低 (P < 0.05)。 LA突发起搏后，Sham组所有10只犬（100%）均可诱发AF，而LRDN组10只犬中仅4只（40%）可诱发AF（P=0.011）。 LRDN组LA突发刺激诱发房颤的比例为26.7%（8/30），较Sham组（53.3%，16/30）显着降低（P=0.035）。此外，与Sham组（20.3±7.3秒，P=0.024）相比，LRDN组的AF持续时间也显着缩短（13.3±5.1秒）。结论 RDN经RAAC可引起心脏神经重塑，有效抑制AF诱发，缩短AF持续时间。它可能有助于选择 AF 患者的治疗方法。
Introduction Catheter-based renal denervation (RDN) could reduce cardiac sympathetic nerve activity (SNA) and inhibit atrial fibrillation (AF). However, the reliability is uncertain, because the renal sympathetic nerves are mainly distributed in the adventitial surface of the renal artery. Objective The aims of this study were to test the hypothesis that renal artery adventitial ablation (RAAA) definitely had the effects of RDN and to study the effects of RDN via renal artery adventitial cryoablation (RAAC) on AF and cardiac neural remodeling. Methods Twenty beagle canines were randomly assigned to two groups: the left RDN group (LRDN, n=10), which underwent left RDN via RAAC; the Sham group (n=10). After 2 months of postoperative recovery, AF vulnerability, AF duration, and histological examination were performed in both groups. Results Compared with the Sham group, left stellate ganglion (LSG) tissue fibrosis was increased in the LRDN group. LRDN significantly increased the percentage of TH-negative ganglionic cells and decreased the density of TH-positive nerves in the LSG (P < 0.001). Also, the densities of TH-positive nerves and GAP43 immunoreactivity within the left atrium (LA) were significantly decreased in the LRDN group (P < 0.05). After LA burst pacing, all 10 canines (100%) could be induced AF in the Sham group, but only 4 of 10 canines (40%) could be induced AF in the LRDN group (P=0.011). The percentage of LA burst stimulation with induced AF was 26.7% (8/30) in the LRDN group, which was significantly decreased compared with that of the Sham group (53.3%, 16/30) (P=0.035). In addition, AF duration was also significantly decreased in the LRDN group (13.3 ± 5.1 s) compared with that of the Sham group (20.3 ± 7.3 s, P=0.024). Conclusions RDN via RAAC could cause cardiac neural remodeling and effectively inhibit AF inducibility and shorten AF duration. It may be useful in selecting therapeutic approaches for AF patients.