超声引导心外迷走神经刺激——心神经消融术中迷走神经可视化的新方法。
Ultrasound-guided extracardiac vagal stimulation-New approach for visualization of the vagus nerve during cardioneuroablation.
机构信息
Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland.
Department of Cardiology, Centre of Postgraduate Medical Education, Grochowski Hospital, Warsaw, Poland.
出版信息
Heart Rhythm. 2022 Aug;19(8):1247-1252. doi: 10.1016/j.hrthm.2022.04.014. Epub 2022 Apr 22.
BACKGROUND
Fluoroscopy-guided extracardiac vagal stimulation (ECVS) from the internal right and left jugular veins (RIJV and LIJV) is routinely used to document vagal response (sinus arrest and/or atrioventricular block) during cardioneuroablation. Ultrasound-guided ECVS allows direct visualization and selective stimulation of the vagus nerve (VN).
OBJECTIVES
The objectives of this study were to assess the feasibility of ultrasound-guided ECVS and to compare it with fluoroscopy-guided ECVS.
METHODS
The study group consisted of 48 patients (25 men [52%]; mean age 38 ± 15 years) in whom fluoroscopy-guided ECVS and ultrasound-guided ECVS were performed. For fluoroscopy-guided ECVS, a pacing electrode was introduced into the RIJV and into the LIJV up to the level of the jugular foramen under fluoroscopic guidance. For ultrasound-guided ECVS, the VN and electrode were visualized using ultrasonography. Partial vagal response was defined as induction of sinus arrest or atrioventricular block, whereas full vagal response was defined as induction of both.
RESULTS
ECVS was performed in all patients from the RIJV and in 45 from the LIJV. Visualization of the VN using ultrasound was possible in 44 patients (92%). During ECVS from the RIJV, partial vagal response was obtained in 39 (81%) using fluoroscopy-guided ECVS vs 45 (94%) using ultrasound-guided ECVS (not significant) whereas full vagal response was obtained in 27 patients (56%) using fluoroscopy-guided ECVS vs 40 (83%) using ultrasound-guided ECVS (P = .0071). For ECVS from the LIJV, partial vagal response was achieved in 40 (89%) vs 44 (98%) patients (not significant) whereas full vagal response was achieved in 30 (67%) vs 40 (89%) patients (P = .021) (fluoroscopy-guided ECVS vs ultrasound-guided ECVS, respectively).
CONCLUSION
Ultrasound-guided ECVS is feasible and full vagal response is achieved significantly more frequently than using fluoroscopy-guided ECVS.
背景
经心外右、左颈内静脉（RIJV 和 LIJV）行透视引导下心外迷走神经刺激（ECVS），常用于记录心神经消融术中的迷走神经反应（窦性停搏和/或房室传导阻滞）。超声引导下的 ECVS 可直接观察和选择性刺激迷走神经（VN）。
目的
本研究旨在评估超声引导下 ECVS 的可行性，并与透视引导下 ECVS 进行比较。
方法
研究组共纳入 48 例患者（25 例男性[52%]；平均年龄 38±15 岁），分别进行透视引导下和超声引导下 ECVS。透视引导下 ECVS 时，在透视引导下将起搏电极经 RIJV 和 LIJV 送入颈静脉孔水平。超声引导下 ECVS 时，使用超声观察 VN 和电极。部分迷走神经反应定义为窦性停搏或房室传导阻滞的诱导，完全迷走神经反应定义为两者均诱导。
结果
所有患者均成功从 RIJV 进行了 ECVS，其中 45 例从 LIJV 进行了 ECVS。44 例（92%）患者可通过超声观察 VN。在 RIJV 行 ECVS 时，透视引导下 ECVS 获得部分迷走神经反应 39 例（81%），超声引导下 ECVS 获得 45 例（94%）（无显著差异）；透视引导下 ECVS 获得完全迷走神经反应 27 例（56%），超声引导下 ECVS 获得 40 例（83%）（P=0.0071）。LIJV 行 ECVS 时，透视引导下 ECVS 获得部分迷走神经反应 40 例（89%），超声引导下 ECVS 获得 44 例（98%）（无显著差异）；透视引导下 ECVS 获得完全迷走神经反应 30 例（67%），超声引导下 ECVS 获得 40 例（89%）（P=0.021）（分别为透视引导下 ECVS 和超声引导下 ECVS）。
结论
超声引导下 ECVS 是可行的，且与透视引导下 ECVS 相比，完全迷走神经反应的获得频率显著更高。
Zotero 插件