Division of Cardiology, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Division of Pulmonary and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Heart Rhythm. 2019 Jan;16(1):117-124. doi: 10.1016/j.hrthm.2018.07.037. Epub 2018 Jul 31.
Bilateral thoracoscopic stellectomy has antiarrhythmic effects, but the procedure is invasive with associated morbidity. Sympathetic nerves from both stellate ganglia form the deep cardiac plexus (CP) in the aortopulmonary window, anterior to the trachea.
The purpose of this study was to demonstrate a novel and minimally invasive transtracheal approach to block the CP in porcine models.
In 12 Yorkshire pigs, right (RSG) and left (LSG) stellate ganglia were electrically stimulated and sympathetic baseline response recorded (hemodynamic parameters and T-wave pattern). Aortopulmonary window was accessed transtracheally with endobronchial ultrasound guidance, and local stimulation of CP confirmed the location. Injection of 1% lidocaine (n = 10) or saline solution (n = 2) was performed, and RSG and LSG responses were re-evaluated and compared with baseline.
Transtracheal lidocaine injection into the CP successfully blocked bilateral sympathetic induced changes (%) in T-wave amplitude (282.8% ± 152.2% vs 20.1% ± 16.5%; P <.001 [LSG]; 338.9% ± 189.8% vs 28% ± 18.3%; P <.001 [RSG]), Tp-Te interval (87.9% ± 37.2% vs 6.9% ± 6.7%; P <.001 [LSG]; 32.6% ± 27.4% vs 6.9% ± 4.7%; P <.035 [RSG]), and left ventricular dP/dT (148.3% ± 108.5% vs 16.5% ± 13.4%; P <.001 [LSG]; 243.1% ± 105.2% vs 19.0% ± 12.4%; P <.001 [RSG]). RSG-induced elevations of systemic, left ventricular, and pulmonary arterial pressures were blocked by lidocaine injection into CP (P <.005 for all comparisons). Stellate ganglia response was not affected in sham studies. No complications were observed during the procedures.
Minimally invasive transtracheal injection of lidocaine into the CP blocked the sympathetic response of either RSG and LSG. Transtracheal assessment of CP may allow for minimally invasive and selective ablation of cardiac innervation, extending the cardiac sympathectomy denervation benefits to those not suitable for surgery.
双侧胸腔镜星状神经节切除术具有抗心律失常作用，但该手术具有侵袭性，相关发病率较高。双侧星状神经节的交感神经在前纵隔的主肺动脉窗形成深部心脏丛（CP），位于气管前方。
本研究旨在证明一种新的微创经气管途径，在猪模型中阻断 CP。
在 12 头约克夏猪中，对右侧（RSG）和左侧（LSG）星状神经节进行电刺激，并记录交感神经基线反应（血流动力学参数和 T 波模式）。在支气管内超声引导下经气管进入主肺动脉窗，并对 CP 进行局部刺激以确认位置。注射 1%利多卡因（n=10）或生理盐水溶液（n=2），并重新评估双侧 RSG 和 LSG 的反应，与基线进行比较。
CP 内经气管注射利多卡因可成功阻断双侧交感神经诱导的 T 波幅度变化（282.8%±152.2%比 20.1%±16.5%；P<.001[LSG]；338.9%±189.8%比 28%±18.3%；P<.001[RSG]）、Tp-Te 间期（87.9%±37.2%比 6.9%±6.7%；P<.001[LSG]；32.6%±27.4%比 6.9%±4.7%；P<.035[RSG]）和左心室 dp/dT（148.3%±108.5%比 16.5%±13.4%；P<.001[LSG]；243.1%±105.2%比 19.0%±12.4%；P<.001[RSG]）。CP 内注射利多卡因可阻断 RSG 诱导的全身、左心室和肺动脉压升高（所有比较均 P<.005）。在假手术研究中，星状神经节反应未受影响。在手术过程中未观察到并发症。
CP 内经气管注射利多卡因可阻断双侧 RSG 和 LSG 的交感神经反应。CP 的经气管评估可能允许对心脏神经支配进行微创和选择性消融，将心脏交感神经切断术的去神经支配益处扩展到不适合手术的患者。
