·432·中国心脏起搏与心电生理杂志2010年第24卷第5期自主神经节丛消融对窦房结及房室结功能的急性期影响吴柳何勃鲁志兵崔博胡笑容温华知江洪[摘要]目的探讨神经节丛(GP)消融对窦房结(SAN)及房室结(AVN)功能的影响。方法7条犬开胸并在左、右心房及肺静脉缝置多极电极导管以备记录及刺激,对左侧及右侧GP分别进行消融,消融前后分别测定静息心率、SAN及AVN功能,SAN功能包括测定6个不同水平起搏周长(380,350,330,300,280及250ms)时SAN恢复时间(SNRT)以及校正的SNRT(cSNRT);AVN功能包括AH间期(His束电图记录的房室结传导时间)、递增起搏时出现文氏房室传导阻滞时起搏周长、出现2:1房室传导阻滞时起搏周长、右房短阵超速起搏诱发心房颤动(简称房颤)时的平均心室率。结果GP消融后窦性心率无显著改变,长起搏周长时SNRT及eSNRT无显著变化,而短起搏周长时则显著减少(P<0.05)。各起搏周长下AH间期、出现文氏房室传导阻滞及2:1房室传导阻滞时的起搏周长、房颤时平均心室率在GP消融前后均无显著变化。结论GP消融在较短起搏周长情况下增强了SAN功能,但对AVN功能无明显影响,可能与GP消融时同时破坏了副交感及交感神经成分有关。[关键词】电生理学;神经节丛;消融;窦房结;房室结DOI:10.3969/j.issn.1007-2659.2010.017中图分类号R454.1R331.3+8文献标识码A文章编号1007—2659(2010)05—0432—04Acuteeffectsofganglionatedplexiablation011sinoatrlalnodalandatrioventricularnodalfunctions.WUIju.HEBo,LUZhi-bing,CUIBo,HUXiao·rong,WENHua-zhi。JIANGHong.DepartmentofCardiology,RenminHospitalofWu-hanUniversity,Wuhan430060,ChinaCorrespondingauthor:JIANGHong,E·mail:jianghon958@印1ail.tom[Abstract]ObjectiveToinvestigatetheeffectsofganglionatedplexi(GP)ablationonthesinoatrialnodal(SAN)andatrioventricnlarnodal(AVN)functions.MethodsInsevenopen-chestdogs,multipleelectrodecathetersweresuturedatbethatriaandpulmonaryveinsforrecordingandpacing.LeftandrightGPwasablatedseparately.Measurementofrestingheartrate,SANandAVNfunctionWasperformedbeforeandafterGPablation.TheSANfunctionwasevaluatedbymea$111七一mentsofsinusnoderecoverytime(SNRT)andcorrectedsinusnoderecoverytime(cSNRT)duringrapidpacingfromthedistalpairofRAcatheterat6levelsofdecrementalpacingcyclelength(CL,ins):380,350,330,300,280and250.TheAVNfunctionwasevaluatedbymeasurementsof①AHintervalatincrementalrightatrium(RA)pacing;(墓)thepacingCLatwhichWenckebachatrioventricularblock(AVB)occurredduringincrementalpacing(10瑚steps);③t}IepacingCLatwhich2:1AVblockOCCUlTedand④theaverageventricularratewhenatrialfibrillation(AF)Wasinducedbyburstpa-cingattheRA.ResultsThesinusratedidnotsignificantlychangeafterGPablations.TheSNRT,cSNRTdidnotshowsignificantchangesatlongpacingCLs,butsignificantlydecreasedatshorterCLsafterGPablations.TheAHintervalatdifferentpacingCLs,theWenckebachAVBCL,2:1AVBCLortheventrieularrateduringAFwerenotsignificantlyal—teredbyGPablations.ConclmionsGPablationenhancesSANfunctiononlyatshortpacingCLsanddoesnotchangeAVNfunction.TheseresultsmaybepartiallyrelatedtodestroyingbethparasympatheticandsympatheticelementsintheGPbyablation.[ChineseJournalofCardiacPacingandElectrophysiology,2010,24(5):432—435][Keywords]Electrophysiology;Ganglionatedplexi;Ablation;Sinoatrialnode;Atrioventricularnode·国家自然科学基金资助项目(项日编号:30700313);武汉市学科带头人计划项目(项目编号:200750730309);武汉大学2008年博士研究生(含l+4)自主科研项目(项H编号:20083020101000062)作者单位:武汉大学人民医院心内科(湖北武汉430060)作者简介:吴柳(1983一),女(汉族),湖北潜江人,博士研究生,研究方向为心律失常。...