心脏神经消融术中神经节丛消融顺序对迷走神经反应、心率和血压的影响。
The impacts of the ganglionated plexus ablation sequence on the vagal response, heart rate, and blood pressure during cardioneuroablation.
机构信息
Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai, China; Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
出版信息
Auton Neurosci. 2021 Jul;233:102812. doi: 10.1016/j.autneu.2021.102812. Epub 2021 Apr 20.
AIMS
Cardioneuroablation is an emerging and promising therapy to treat vasovagal syncope (VVS). The aim of this study was to assess the characteristics of vagal response (VR), heart rate (HR), and blood pressure (BP) during cardioneuroablation with different sequences of ganglionated plexus (GPs) catheter ablation and clarify the regulatory mechanism of cardiac GPs of the left atrium.
METHODS
A total of 28 patients with VVS who underwent cardioneuroablation were prospectively enrolled and randomly assigned to 2 groups according to the ablation order of GPs. Group A: Left superior GP (LSGP) - Left inferior GP (LIGP) - Right inferior GP (RIGP) - Right anterior GP (RAGP); Group B: RAGP - LSGP - LIGP - RIGP.
RESULTS
In Group A, the VR in LSGP, LIGP, RIGP, and RAGP during ablation was observed in 11 (78.6%), 5 (35.7%), 4 (28.6%) and 2 (14.3%) cases, respectively. In contrast, in Group B, the VR in RAGP, LSGP, LIGP, and RIGP was observed in 2 (14.3%), 1 (7.1%), 0 (0%) and 0 (0%) cases, respectively. BP reduction during procedure was observed eight times in Group A and once in Group B (P = 0.013). In both groups, the HR increased significantly during ablation of the RAGP (all P < 0.001).
CONCLUSION
The sequence of GPs ablation during cardioneuroablation affected the occurrence rate of VR and BP reduction during cardioneuroablation. The RAGP was a critical target to increase HR and inhibit VR and BP reduction during procedure, indicating that it may be a key GP in regulation of the cardiac vagal activity.
目的
心脏神经消融术是一种新兴且有前途的治疗血管迷走性晕厥（VVS）的方法。本研究旨在评估不同节段神经丛（GP）导管消融过程中心血管迷走反应（VR）、心率（HR）和血压（BP）的特点，并阐明左心房心脏 GP 的调节机制。
方法
前瞻性纳入 28 例接受心脏神经消融术的 VVS 患者，根据 GP 消融顺序将其随机分为 2 组。A 组：左上部 GP（LSGP）-左下部 GP（LIGP）-右下部 GP（RIGP）-右前 GP（RAGP）；B 组：RAGP-LSGP-LIGP-RIGP。
结果
A 组消融 LSGP、LIGP、RIGP 和 RAGP 时观察到 VR 的分别为 11 例（78.6%）、5 例（35.7%）、4 例（28.6%）和 2 例（14.3%）。相反，B 组消融 RAGP、LSGP、LIGP 和 RIGP 时观察到 VR 的分别为 2 例（14.3%）、1 例（7.1%）、0 例（0%）和 0 例（0%）。A 组有 8 次观察到术中 BP 下降，B 组有 1 次（P=0.013）。在两组中，RAGP 消融时 HR 均显著增加（均 P<0.001）。
结论
心脏神经消融术中 GP 消融顺序影响 VR 及术中 BP 下降的发生率。RAGP 是增加 HR、抑制 VR 和术中 BP 下降的关键靶点，提示其可能是调节心脏迷走神经活动的关键 GP。
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