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神经节丛消融术治疗心房颤动

Ganglionated Plexi Ablation for the Treatment of Atrial Fibrillation.

作者信息

Avazzadeh Sahar, McBride Shauna, O'Brien Barry, Coffey Ken, Elahi Adnan, O'Halloran Martin, Soo Alan, Quinlan Leo R

机构信息

Physiology and Human Movement Laboratory, CÚRAM SFI Centre for Research in Medical Devices, School of Medicine, Human biology building, National University of Ireland (NUI) Galway, H91 TK33 Galway, Ireland.

AtriAN Medical Limited, Unit 204, NUIG Business Innovation Centre, Upper Newcastle, H91 TK33 Galway, Ireland.

出版信息

J Clin Med. 2020 Sep 24;9(10):3081. doi: 10.3390/jcm9103081.

Abstract

Atrial fibrillation (AF) is the most common type of cardiac arrhythmia and is associated with significant morbidity and mortality. The autonomic nervous system (ANS) plays an important role in the initiation and development of AF, causing alterations in atrial structure and electrophysiological defects. The intrinsic ANS of the heart consists of multiple ganglionated plexi (GP), commonly nestled in epicardial fat pads. These GPs contain both parasympathetic and sympathetic afferent and efferent neuronal circuits that control the electrophysiological properties of the myocardium. Pulmonary vein isolation and other cardiac catheter ablation targets including GP ablation can disrupt the fibers connecting GPs or directly damage the GPs, mediating the benefits of the ablation procedure. Ablation of GPs has been evaluated over the past decade as an adjunctive procedure for the treatment of patients suffering from AF. The success rate of GP ablation is strongly associated with specific ablation sites, surgical techniques, localization techniques, method of access and the incorporation of additional interventions. In this review, we present the current data on the clinical utility of GP ablation and its significance in AF elimination and the restoration of normal sinus rhythm in humans.

摘要

心房颤动(AF)是最常见的心律失常类型,与显著的发病率和死亡率相关。自主神经系统(ANS)在AF的发生和发展中起重要作用,导致心房结构改变和电生理缺陷。心脏的固有ANS由多个神经节丛(GP)组成,通常位于心外膜脂肪垫中。这些GP包含控制心肌电生理特性的副交感和交感传入及传出神经回路。肺静脉隔离和包括GP消融在内的其他心脏导管消融靶点可破坏连接GP的纤维或直接损伤GP,从而介导消融手术的益处。在过去十年中,GP消融已作为治疗AF患者的辅助手术进行了评估。GP消融的成功率与特定的消融部位、手术技术、定位技术、接入方法以及是否纳入额外干预措施密切相关。在本综述中,我们展示了关于GP消融临床应用的当前数据及其在消除人类AF和恢复正常窦性心律方面的意义。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7cd3/7598705/cfd60b81a3d2/jcm-09-03081-g001.jpg

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