Intraoperative epicardial electrophysiologic mapping and isolation of autonomic ganglionic plexi
Intraoperative epicardial electrophysiologic mapping and isolation of autonomic ganglionic plexi
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DOI：
10.1016/j.athoracsur.2006.09.022
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发表时间：
2007-02-01
影响因子：
4.6
通讯作者：
Wolf, Randall K.
中科院分区：
文献类型：
--
作者：
Mehall, John R.;Kohut, Robert M., Jr.;Wolf, Randall K.
背景。自主神经节神经丛（GPs）被认为是单发心房颤动（AF）的触发因素。本研究的目的是描述心外膜电生理标测的技术和结果，以及GP隔离的早期效果。术中心外膜电生理测图连续对41例房颤独立微创手术患者进行。绘制了一幅标记解剖位置的图来描述结果。术中高频刺激（800/分钟，12 ~ 16 mA，脉冲持续时间9.9 ms）采用标准四极导管直接置于心外膜上。刺激导致心室减慢并使心电图R-R间期加倍的位置被定义为活跃全科医生。对这些区域进行了绘制和描述。干双极射频隔离后，再次刺激这些部位以评估隔离效果。41例患者（平均年龄60.2岁，男性31例）接受房颤手术治疗（间歇性房颤28例，慢性房颤13例）。所有患者均有主动全科医生（24例双侧，17例单侧）。右侧平均为5.0 gp，左侧平均为2.7 gp。超过50%的患者在右侧心房间沟和马歇尔韧带处有活跃的全科医生。所有站点在射频隔离后都处于非活动状态。15例患者随访6个月，其中14例患者无af。自主全科医生可以在房颤手术中使用高频刺激进行常规识别。GP聚集在房间沟和马歇尔韧带周围，心脏对GP刺激的反应可以通过双极射频隔离消除。在双侧肺静脉隔离的基础上增加GP隔离可能增加房颤的自由度。(c) 2007年由胸外科学会发布。
Background. Autonomic ganglionic plexi (GPs) have been implicated as triggers in lone atrial fibrillation (AF). The purpose of this study was to describe the technique and results of epicardial electrophysiologic mapping and the early effects of GP isolation.Methods. Intraoperative epicardial electrophysiologic mapping was performed on 41 consecutive patients during a stand-alone minimally invasive operation for AF. A map labeling anatomic locations was developed to describe the findings. Intraoperative high-frequency stimulation (800/minute, 12 to 16 mA, pulse duration 9.9 ms) was performed using a standard quadripolar catheter placed directly on the epicardium. Locations where stimulation resulted in ventricular slowing with doubling of the electrocardiographic R-R interval were defined as active GPs. These areas were mapped and described. After dry bipolar radiofrequency isolation, the sites were again stimulated to assess isolation.Results. Forty-one patients ( mean age of 60.2 years, 31 males) underwent operation for AF ( 28 intermittent AF, 13 chronic). Active GPs were identified in all patients ( 24 bilateral, 17 unilateral). There was a mean of 5.0 GPs on the right and 2.7 on the left. More than 50% of patients had active GPs along the interatrial groove on the right and along the ligament of Marshall. All sites were inactive after radiofrequency isolation. Six-month follow-up is available for 15 patients, with 14 patients free of AF.Conclusions. Autonomic GPs can be routinely identified during AF surgery utilizing high-frequency stimulation. The GPs are clustered around the interatrial groove and the ligament of Marshall, and the cardiac response to GP stimulation can be eliminated with bipolar radiofrequency isolation. The addition of GP isolation to bilateral pulmonary vein isolation may increase freedom from AF. (c) 2007 by The Society of Thoracic Surgeons.