Yoshida Naoki, Yamada Takumi, Murakami Yoshimasa, Okada Taro, Ninomiya Yuichi, Toyama Junji, Yoshida Yukihiko, Tsuboi Naoya, Muto Masahiro, Inden Yasuya, Hirai Makoto, Murohara Toyoaki
Department of Cardiology, Nagoya University Graduate School of Medicine, and Division of Cardiology, Nagoya Dai-ni Red Cross Hospital, Cardivascular Center, Nagoya, Japan.
Circ J. 2009 Apr;73(4):632-8. doi: 10.1253/circj.cj-08-0599. Epub 2009 Feb 19.
The relationship between vagal modification and paroxysmal atrial fibrillation (PAF) recurrence after segmental pulmonary vein (PV) isolation (S-PVI) was investigated.
S-PVI was performed in 77 PAF patients using a multielectrode basket or circular catheter to achieve electrical disconnection of all 4 PVs independent of eliminating vagal reflexes. Serial Holter-recordings were obtained at baseline, immediately and 1, 3, 6, and 12 months after S-PVI to analyze the heart rate variability. Fifty-one patients were free from symptomatic PAF (Group A) and 26 had late PAF recurrences (Group B) at 12-month follow-up. Immediately after S-PVI, the root mean square of the successive differences (rMSSD) and high-frequency (HF) power, which reflected parasympathetic nervous activity, were significantly lower in Group A than in Group B (rMSSD: 33.6+/-26.0 vs 60.6+/-23.2 ms, P<0.05; ln HF: 8.73+/-0.84 vs 9.31+/-0.95 ms2, P<0.05). There were no significant differences in the average heart rate or ratio of the low-frequency to HF powers between the 2 groups. By multivariate analysis, only the HF immediately after S-PVI was an independent predictor of PAF recurrence (hazard ratio 1.707, 95% confidence interval 1.057-2.756, P<0.05).
Vagal modification after S-PVI could also help prevent late recurrence of PAF.
研究了节段性肺静脉隔离（S-PVI）后迷走神经调节与阵发性心房颤动（PAF）复发之间的关系。
对77例PAF患者进行S-PVI，使用多电极篮状导管或环形导管实现所有4条肺静脉的电隔离，而不考虑消除迷走神经反射。在基线、S-PVI后即刻、1、3、6和12个月时进行连续动态心电图记录，以分析心率变异性。在12个月随访时，51例患者无有症状的PAF复发（A组），26例有PAF晚期复发（B组）。S-PVI后即刻，反映副交感神经活动的连续差值的均方根（rMSSD）和高频（HF）功率，A组显著低于B组（rMSSD：33.6±26.0对60.6±23.2 ms，P<0.05；ln HF：8.73±0.84对9.31±0.95 ms2，P<0.05）。两组之间的平均心率或低频与HF功率之比无显著差异。通过多变量分析，仅S-PVI后即刻的HF是PAF复发的独立预测因素（风险比1.707，95%置信区间1.057-2.756，P<0.05）。
S-PVI后迷走神经调节也有助于预防PAF的晚期复发。
