Mercader Marco A, He Dingchao, Sharma Aditya C, Marchitto Mark C, Trachiotis Gregory, Bornzin Gene A, Jonas Richard, Moak Jeffrey P
Department of Medicine, Division of Cardiology, George Washington University, Washington, D.C., United States of America.
Department of Surgery, Division of Cardiac Surgery, Children's National Health System, Washington, D.C., United States of America.
PLoS One. 2017 Sep 13;12(9):e0183804. doi: 10.1371/journal.pone.0183804. eCollection 2017.
Junctional ectopic tachycardia (JET) and atrial fibrillation (AF) occur in patients recovering from open-heart surgery (OHS). Pharmacologic treatment is used for the control of post-operative atrial arrhythmias (POAA), but is associated with side effects. There is a need for a reversible, modulated solution to rate control. We propose a non-pharmacologic technique that can modulate AV nodal conduction in a selective fashion. Ten mongrel dogs underwent OHS. Stimulation of the anterior right (AR) and inferior right (IR) fat pad (FP) was done using a 7-pole electrode. The IR was more effective in slowing the ventricular rate (VR) to AF (52 +/- 20 vs. 15 +/- 10%, p = 0.003) and JET (12 +/- 7 vs. 0 +/- 0%, p = 0.02). Selective site stimulation within a FP region could augment the effect of stimulation during AF (57 +/- 20% (maximum effect) vs. 0 +/- 0% (minimum effect), p<0.001). FP stimulation at increasing stimulation voltage (SV) demonstrated a voltage-dependent effect (8 +/- 14% (low V) vs. 63 +/- 17 (high V) %, p<0.001). In summary, AV node fat pad stimulation had a selective effect on the AV node by decreasing AV nodal conduction, with little effect on atrial activity.
交界性异位性心动过速（JET）和心房颤动（AF）发生于接受心脏直视手术（OHS）后的患者。药物治疗用于控制术后房性心律失常（POAA），但会伴有副作用。需要一种可逆的、可调节的心率控制解决方案。我们提出一种非药物技术，该技术能够以选择性方式调节房室结传导。十只杂种犬接受了心脏直视手术。使用七极电极刺激右前（AR）和右下（IR）脂肪垫（FP）。IR在减慢房颤时的心室率（VR）方面更有效（52±20%对15±10%，p = 0.003），在减慢JET时的心室率方面也更有效（12±7%对0±0%，p = 0.02）。在FP区域内进行选择性部位刺激可增强房颤期间的刺激效果（最大效果为57±20%对最小效果为0±0%，p<0.001）。随着刺激电压（SV）增加进行FP刺激显示出电压依赖性效应（低电压时为8±14%对高电压时为63±17%，p<0.001）。总之，房室结脂肪垫刺激通过降低房室结传导对房室结产生选择性作用，而对心房活动影响很小。
