Zhao Liang, Jiang Weifeng, Zhou Li, Wang Yuanlong, Zhang Xiaodong, Wu Shaohui, Xu Kai, Liu Xu
Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiaotong University, 241 West Huaihai Road, Shanghai, 200030, China.
J Interv Card Electrophysiol. 2015 Aug;43(2):151-9. doi: 10.1007/s10840-015-9981-8. Epub 2015 Feb 19.
Multiple lead and generator replacement and related complications often complicate the decision of pacemaker implantation in non-elderly patients with symptomatic bradycardia. This study sought to investigate the efficacy and safety of atrial autonomic denervation for treating the symptomatic long-standing sinus bradycardia (SB) in non-elderly patients.
Eleven non-elderly patients (mean age, 45.9 ± 10.9 years; eight men) with a long history of SB (106.2 ± 43.7 months; range, 60-189) were enrolled. Five atrial ganglionated plexies (GPs), identified by anatomic distribution and high-frequency stimulation, were targeted and ablated. The end point was elimination of the vagal response at ablation sites. The symptoms of SB and Holter were followed up at 3 days, 6, and 12 months and, thereafter, over a period of 18 months. Six patients were under 50 years old (group I) and 5 patients were between 50 and 60 years old (group II). There were 3.1 ± 0.7 GPs with positive vagal response and 11.3 ± 2.7 ablation sites in each patient. During the 18.4 ± 6.2 (range, 12-25) months of follow-up, all patients reported significant symptom improvement with a significant decrease of the SB-related symptoms score. The total heartbeats, mean, and minimum heart rate significantly increased that persisted for 12 months. Compared with patients in group II, those in group I had more increases in total heartbeats and mean heart rate (HR).
Atrial autonomic denervation increases sinus rate and improves symptoms in non-elderly patients with symptomatic long-standing SB, thus, potentially serving as an alternative to pacemaker implantation.
在有症状的非老年心动过缓患者中，多次更换导线和发生器以及相关并发症常常使起搏器植入决策变得复杂。本研究旨在探讨心房自主神经去神经支配治疗非老年患者有症状的长期窦性心动过缓（SB）的有效性和安全性。
纳入11例有长期SB病史（106.2±43.7个月；范围60 - 189个月）的非老年患者（平均年龄45.9±10.9岁；8例男性）。通过解剖分布和高频刺激识别出5个心房神经节丛（GPs）并进行消融。终点是消除消融部位的迷走神经反应。在3天、6个月和12个月以及之后的18个月期间对SB症状和动态心电图进行随访。6例患者年龄小于50岁（I组），5例患者年龄在50至60岁之间（II组）。每位患者有3.1±0.7个有迷走神经反应的GPs和11.3±2.7个消融部位。在18.4±6.2（范围12 - 25）个月的随访期间，所有患者均报告症状有显著改善，与SB相关的症状评分显著降低。总心跳数、平均心率和最低心率显著增加，且持续12个月。与II组患者相比，I组患者的总心跳数和平均心率（HR）增加更多。
心房自主神经去神经支配可提高非老年有症状长期SB患者的窦性心率并改善症状，因此有可能作为起搏器植入的替代方法。
