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非药物、非消融方法治疗心房颤动:实验证据与潜在临床意义。

Non-pharmacological, non-ablative approaches for the treatment of atrial fibrillation: experimental evidence and potential clinical implications.

机构信息

Heart Rhythm Institute, University of Oklahoma Health Sciences Center, 1200 Everett Drive, Rm 6E103, Oklahoma City, OK 73104, USA.

出版信息

J Cardiovasc Transl Res. 2011 Feb;4(1):35-41. doi: 10.1007/s12265-010-9231-5. Epub 2010 Nov 6.


DOI:10.1007/s12265-010-9231-5
PMID:21057908
Abstract

In this review, we initially covered the basic and clinical reports that provided the prevalent concepts underlying the mechanisms for atrial fibrillation (AF). The clinical evolution of catheter ablation and its eventual application to AF has also been detailed. A critique of the results based on a review of the literature has shown that either or both drugs or catheter ablation therapy for preventing AF recurrences have significant limitations and even serious complications. Finally, we have presented recent experimental studies which suggest that an alternative approach to reducing AF inducibility can be achieved with low-level autonomic nerve stimulation. Specifically, electrical stimulation of the vago-sympathetic trunks, at levels well below that which slows the heart rate can significantly increase AF thresholds and suppress AF inducibility. Further studies will determine if this new method can be used as an effective means of treating some forms of clinical AF.

摘要

在这篇综述中,我们首先介绍了基础和临床报告,这些报告提供了房颤(AF)机制背后的流行概念。导管消融的临床进展及其最终在 AF 中的应用也已详细描述。基于文献回顾对结果的评价表明,预防 AF 复发的药物或导管消融治疗均存在显著局限性,甚至严重并发症。最后,我们提出了最近的实验研究,表明通过低水平自主神经刺激可以实现降低 AF 易感性的替代方法。具体来说,在远低于减慢心率的水平刺激迷走-交感干,可以显著提高 AF 阈值并抑制 AF 的可诱导性。进一步的研究将确定这种新方法是否可以用作治疗某些临床 AF 的有效手段。

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[1]
Non-pharmacological, non-ablative approaches for the treatment of atrial fibrillation: experimental evidence and potential clinical implications.

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引用本文的文献

[1]
Clinical Effects of "Selective Drug" Regulating Vagus Nerve Signal Pathway in Vagally-Mediated Atrial Fibrillation.

Med Sci Monit. 2018-4-13

[2]
Vagal stimulation targets select populations of intrinsic cardiac neurons to control neurally induced atrial fibrillation.

Am J Physiol Heart Circ Physiol. 2016-11-1

[3]
Intermittent low-level vagosympathetic nerve trunk stimulation inhibits ganglionated plexi activity to prevent atrial fibrillation.

Int J Clin Exp Med. 2015-4-15

[4]
Role of neural modulation in the pathophysiology of atrial fibrillation.

Indian J Med Res. 2014-4

[5]
Continuous low-level vagus nerve stimulation reduces stellate ganglion nerve activity and paroxysmal atrial tachyarrhythmias in ambulatory canines.

Circulation. 2011-5-9

本文引用的文献

[1]
Updated worldwide survey on the methods, efficacy, and safety of catheter ablation for human atrial fibrillation.

Circ Arrhythm Electrophysiol. 2009-12-7

[2]
Low-level vagosympathetic stimulation: a paradox and potential new modality for the treatment of focal atrial fibrillation.

Circ Arrhythm Electrophysiol. 2009-12

[3]
Atrial fibrillation begets atrial fibrillation: autonomic mechanism for atrial electrical remodeling induced by short-term rapid atrial pacing.

Circ Arrhythm Electrophysiol. 2008-8

[4]
Transcutaneous vagus nerve stimulation may attenuate postoperative cognitive dysfunction in elderly patients.

Med Hypotheses. 2009-7-23

[5]
Neurobiological principles in the etiopathogenesis of disease: when diseases have a head.

Med Sci Monit. 2009-1

[6]
Cholinergic modulation of inflammation.

Int J Clin Exp Med. 2008

[7]
Ablation of ganglionic plexi during combined surgery for atrial fibrillation.

Ann Thorac Surg. 2008-11

[8]
Comparison of atrial fibrillation inducibility by electrical stimulation of either the extrinsic or the intrinsic autonomic nervous systems.

J Interv Card Electrophysiol. 2009-1

[9]
Nitric oxide signaling and the regulation of myocardial function.

J Mol Cell Cardiol. 2008-11

[10]
Evaluation of catheter ablation of periatrial ganglionic plexi in patients with atrial fibrillation.

Am J Cardiol. 2008-9-1

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