Intrinsic Cardiac Autonomic Stimulation Induces Pulmonary Vein Ectopy and Triggers Atrial Fibrillation in Humans
Intrinsic Cardiac Autonomic Stimulation Induces Pulmonary Vein Ectopy and Triggers Atrial Fibrillation in Humans
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DOI：
10.1111/j.1540-8167.2010.01992.x
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发表时间：
2011-06-01
影响因子：
2.7
通讯作者：
Kanagaratnam, Prapa
中科院分区：
文献类型：
--
作者：
Lim, Phang Boon;Malcolme-Lawes, Louisa C.;Kanagaratnam, Prapa
导言：肺静脉（PV）异位诱发心房颤动（AF）已被很好地描述。这些PV异位的触发因素还不是很清楚。心脏内在自主神经系统（ANS）已被认为是可能导致PV异位和心房颤动（AF）的潜在上游调节因子。我们假设高频刺激（HFS）心房神经节丛（GP）激活ANS可以引发PV异位。方法和结果：在12例接受阵发性房颤消融治疗的患者的窦性心律期间，在假定的GP部位进行与局部心房不应期同步的短脉冲HFS。分别在左室、冠状窦（CS）和右高心房（HRA）置入导管，记录心电图。共记录了112例HFS，其中91例（81%）发生异位活动。91次发作中，孤立性单次异位搏动46次，双次异位反应5次，24次异位/心动过速持续30 s。在91次发作中，有63次将PV导管放置在受刺激的GP附近，导致63次发作中有48次（76%）PV导管最早记录到异位。在一名患者中，可重复的异位发生在对HFS反应的房室结传导延迟后。无HFS时，房室结传导延迟和异位均未发生。结论：本研究证明了人类内在心脏自主神经系统的激活与肺静脉异位之间的直接联系。（J cardiovascular Electrophysiol, Vol. 22, pp. 638-646, 2011年6月）
Autonomic Stimulation Induces PV Ectopy and AF. Introduction: The induction of atrial fibrillation (AF) by pulmonary vein (PV) ectopy is well described. The triggers for these PV ectopy are not so well understood. The intrinsic cardiac autonomic nervous system (ANS) has been suggested as a potential upstream regulator that may cause PV ectopy and atrial fibrillation (AF). We hypothesized that activation of the ANS by high frequency stimulation (HFS) of atrial ganglionated plexi (GP) can initiate PV ectopy.Methods and Results: During sinus rhythm in 12 patients undergoing ablation for paroxysmal AF, short bursts of HFS, synchronized to the local atrial refractory period, were delivered at presumed GP sites. Electrograms were recorded from catheters placed in the PV, coronary sinus (CS) and high right atrium (HRA). A total of 112 episodes of HFS were recorded, producing ectopic activity in 91 of 112 (81%) episodes. Of these 91 episodes, there were 46 episodes of isolated single ectopic beats, 5 episodes of double ectopic responses, 24 episodes of ectopy/tachycardia lasting 30 s. In 63 of 91 episodes, the PV catheter was placed adjacent to the stimulated GP, resulting in ectopy recorded earliest in the PV catheter in 48 of 63 (76%) episodes. In one patient, reproducible ectopy was shown to occur following AV nodal conduction delay in response to HFS. Without HFS, neither AV nodal conduction delay nor ectopy occurred.Conclusions: This study has demonstrated a direct link between activation of the intrinsic cardiac autonomic nervous system and pulmonary vein ectopy in humans. (J Cardiovasc Electrophysiol, Vol. 22, pp. 638-646, June 2011)