通过选择性心外膜迷走脂肪垫刺激进行术后房颤管理。
Post-operative atrial fibrillation management by selective epicardial vagal fat pad stimulation.
作者信息
Rossi Pietro, Bianchi Stefano, Barretta Antonio, Della Scala Alberto, Kornet Lilian, De Paulis Ruggero, Bellisario Alessandro, D'Addio Vittorio, Pavaci Herribert, Miraldi Fabio
机构信息
Department of Medicine, Unit of Electrophysiology, Belcolle Hospital, Viterbo, Italy.
出版信息
J Interv Card Electrophysiol. 2009 Jan;24(1):37-45. doi: 10.1007/s10840-008-9286-2. Epub 2008 Aug 30.
PURPOSE
Post-operative atrial fibrillation (POAF) is a common complication after cardiac surgery and often leads to poorly tolerated fast ventricular rates. Negative dromotropic drugs are not always effective and may not be well tolerated in heart failure patients. Aim of this study is to verify if high-frequency stimulation of the right inferior fat pad (RIFPS) allows an effective decrease in ventricular rate (VR) during POAF.
METHODS
We enrolled 32 consecutive patients submitted to bypass; during surgery, a temporary heart wire was implanted in a site where RIFPS evoked a functional AV block. During POAF, RIFPS was delivered from the heart wire to decrease VR.
RESULTS
Intra-operative RIFPS evoked complete AV block in 29 patients (91%). Fourteen patients (44%) developed POAF (mean VR 127 +/- 12 bpm). In these patients, RIFPS achieved a 25% reduction of VR and complete AV block with 6.0 +/- 1.9 and 7.5 +/- 1.8 V (duration 0.2 ms, frequency 50 Hz), respectively.
CONCLUSION
Epicardial RIFPS represents an effective and feasible technique to decrease VR during POAF.
目的
术后心房颤动（POAF）是心脏手术后常见的并发症，常导致心室率过快且耐受性差。负性变传导药物并不总是有效，且心力衰竭患者可能耐受性不佳。本研究的目的是验证右下心房脂肪垫（RIFPS）的高频刺激是否能在POAF期间有效降低心室率（VR）。
方法
我们纳入了32例连续接受搭桥手术的患者；手术期间，在RIFPS诱发功能性房室传导阻滞的部位植入临时心脏导线。在POAF期间，通过心脏导线进行RIFPS以降低VR。
结果
术中RIFPS在29例患者（91%）中诱发了完全性房室传导阻滞。14例患者（44%）发生了POAF（平均VR 127±12次/分钟）。在这些患者中，RIFPS分别以6.0±1.9伏和7.5±1.8伏（持续时间0.2毫秒，频率50赫兹）使VR降低了25%并诱发了完全性房室传导阻滞。
结论
心外膜RIFPS是一种在POAF期间降低VR的有效且可行的技术。
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