From the Department of Cardiology, Center for Atrial Fibrillation, Beijing Anzhen Hospital, Beijing, China (J.M., J.D., C.M.); Center for Atrial Fibrillation, Heart Center, Beijing Chao-Yang Hospital, Beijing, China (X.Y., Q.Y., X.L.); and Cardiovascular Center, Beijing Tongren Hospital, Capital Medical University, Beijing, China (Y.Z.).
Circ Arrhythm Electrophysiol. 2014 Aug;7(4):711-7. doi: 10.1161/CIRCEP.113.000799. Epub 2014 May 23.
Previous studies have suggested that systematic ablation of ganglionated plexi (GP) could increase the short-term success rate of radiofrequency ablation for atrial fibrillation, but the long-term efficacy of this approach is not fully established.
Twenty-four mongrel dogs were divided into 3 groups: epicardial GP ablation group 1 (n=8), epicardial GP ablation group 2 (n=8), and a sham operation group (n=8). In the 2 epicardial GP ablation groups, the 4 major GP and the ligament of Marshall were systematically ablated. The effective refractory period and inducibility of tachyarrhythmias were measured before and immediately after GP ablation in epicardial GP ablation group 1 and 8 weeks later in the other 2 groups. Tyrosine hydroxylase and choline acetyltransferase expressions were also determined immunohistochemically 8 weeks later in the latter groups. Compared with epicardial GP ablation group 1 and the sham operation group, epicardial GP ablation group 2 had the shortest atrial and ventricular effective refractory period and the highest inducibility of atrial tachyarrhythmias. The inducibility of ventricular tachyarrhythmias among the 3 groups was comparable. The density of tyrosine hydroxylase- and choline acetyltransferase-positive nerves in the atrium was the highest in epicardial GP group 2, whereas there were no significant intergroup differences in the densities of these 2 types of nerves in the ventricle.
After 8 weeks of healing, epicardial GP ablation without additional atrial ablation was potentially proarrhythmic, which may be attributable to decreased atrial effective refractory period and hyper-reinnervation involving both sympathetic and parasympathetic nerves.
先前的研究表明，系统消融神经节丛（GP）可以提高射频消融治疗房颤的短期成功率，但这种方法的长期疗效尚未完全确定。
24 只杂种狗分为 3 组：心外膜 GP 消融组 1（n=8）、心外膜 GP 消融组 2（n=8）和假手术组（n=8）。在 2 个心外膜 GP 消融组中，系统消融 4 个主要 GP 和 Marshall 韧带。在 GP 消融组 1 中，在心外膜 GP 消融前后测量有效不应期和心动过速的诱发性，并在其他 2 组的 8 周后测量。8 周后，在后 2 组中还通过免疫组织化学方法测定酪氨酸羟化酶和胆碱乙酰转移酶的表达。与心外膜 GP 消融组 1 和假手术组相比，心外膜 GP 消融组 2 的心房和心室有效不应期最短，心房心动过速的诱发性最高。3 组之间的室性心动过速诱发性相似。心房中酪氨酸羟化酶和胆碱乙酰转移酶阳性神经的密度在心外膜 GP 组 2 中最高，而在心室中这 2 种神经的密度在各组之间没有显著差异。
在心外膜 GP 消融后 8 周的愈合期内，不进行额外的心房消融可能具有致心律失常作用，这可能归因于心房有效不应期缩短和涉及交感神经和副交感神经的神经超再支配。
