Cummings Jennifer E, Gill Inderjit, Akhrass Rami, Dery MarkAlain, Biblo Lee A, Quan Kara J
Heart and Vascular Research Center, MetroHealth Campus, Case Western Reserve University, 2500 MetroHealth Drive, Cleveland, OH 44109, USA.
J Am Coll Cardiol. 2004 Mar 17;43(6):994-1000. doi: 10.1016/j.jacc.2003.07.055.
The goal of this study was to determine if parasympathetic nerves in the anterior fat pad (FP) can be stimulated at the time of coronary artery bypass surgery (CABG), and if dissection of this FP decreases the incidence of postoperative atrial fibrillation (AF).
The human anterior epicardial FP contains parasympathetic ganglia and is often dissected during CABG. Changes in parasympathetic tone influence the incidence of AF.
Fifty-five patients undergoing CABG were randomized to anterior FP preservation (group A) or dissection (group B). Nerve stimulation was applied to the FP before and after surgery. Sinus cycle length (CL) was measured during stimulation. The incidence of postoperative AF was recorded.
Of the 55 patients enrolled, 26 patients were randomized to group A, and 29 patients were randomized to group B. In all of the 55 patients, the FP was identified before initiating cardiopulmonary bypass by CL prolongation with stimulation (865.5 +/- 147.9 ms vs. 957.9 +/- 155.1 ms, baseline vs. stimulation, p < 0.001). In group A, stimulation at the conclusion of surgery increased sinus CL (801.8 +/- 166.4 ms vs. 890.9 +/- 178.2 ms, baseline vs. stimulation, p < 0.001). In group B, repeat stimulation failed to increase sinus CL (853.6 +/- 201.6 ms vs. 841.4 +/- 198.4 ms, baseline vs. stimulation, p = NS). The incidence of postoperative AF in group A (7%) was significantly less than that in group B (37%) (p < 0.01).
This is the first study demonstrating that direct stimulation of the human anterior epicardial FP slows sinus CL. This parasympathetic effect is eliminated with FP dissection. Preservation of the human anterior epicardial FP during CABG decreases incidence of postoperative AF.
本研究的目的是确定在冠状动脉旁路移植术（CABG）时能否刺激前脂肪垫（FP）中的副交感神经，以及该脂肪垫的解剖是否会降低术后房颤（AF）的发生率。
人类心外膜前脂肪垫含有副交感神经节，在CABG期间常被解剖。副交感神经张力的变化会影响房颤的发生率。
55例行CABG的患者被随机分为前脂肪垫保留组（A组）或解剖组（B组）。在手术前后对脂肪垫进行神经刺激。在刺激期间测量窦性周期长度（CL）。记录术后房颤的发生率。
在纳入的55例患者中，26例被随机分配到A组，29例被随机分配到B组。在所有55例患者中，在开始体外循环前通过刺激使CL延长来识别脂肪垫（基线时为865.5±147.9毫秒，刺激时为957.9±155.1毫秒，p<0.001）。在A组中，手术结束时的刺激增加了窦性CL（基线时为801.8±166.4毫秒，刺激时为890.9±178.2毫秒，p<0.001）。在B组中，重复刺激未能增加窦性CL（基线时为853.6±201.6毫秒，刺激时为841.4±198.4毫秒，p=无统计学意义）。A组术后房颤的发生率（7%）显著低于B组（37%）（p<0.01）。
这是第一项表明直接刺激人类心外膜前脂肪垫可减慢窦性CL的研究。这种副交感神经效应在脂肪垫解剖后消失。CABG期间保留人类心外膜前脂肪垫可降低术后房颤的发生率。
