Psychari S N, Theodorakis G N, Koutelou M, Livanis E G, Kremastinos D T
Second Department of Cardiology, Onassis Cardiac Surgery Center, Athens, Greece.
Am J Cardiol. 1998 Mar 15;81(6):725-31. doi: 10.1016/s0002-9149(97)01008-4.
Inappropriate sinus tachycardia and atrial arrhythmias have been reported after radiofrequency ablation. Previous studies have suggested that cardiac denervation is a possible explanation for these rhythm disturbances. The aim of this study was to investigate possible alterations in autonomic innervation of the heart after ablation using the techniques of heart rate variability (HRV) analysis and metaiodobenzylguanidine (I-123 MIBG) scintigraphy. The subjects of this study were 30 consecutive patients aged 25 to 40 years, without structural heart disease, who underwent radiofrequency ablation of atrioventricular nodal slow pathways, and posteroseptal and left lateral accessory pathways because of symptomatic recurrent reentrant tachycardias. Time and frequency domain analysis of HRV after ablation revealed a significant reduction in the indexes of the mean of all 5-minute standard deviation of RR intervals (p = 0.042), low frequency (p = 0.0005), and total frequency (p = 0.008) compared with preablation values in the group of patients who underwent atrioventricular nodal slow pathway ablation. Patients who underwent ablation of a posteroseptal accessory pathway also had significant attenuation of the indexes of standard deviation about the mean RR interval (p = 0.03), standard deviation of 5-minute mean RR intervals (p = 0.006), and low-frequency (p <0.0001), and high-frequency (p <0.0001) components. Significant I-123 MIBG map defects, indicating efferent cardiac sympathetic denervation, were also found in the same groups of patients: atrioventricular nodal group (p = 0.0024), posteroseptal accessory pathway group (p = 0.0007). None of the above changes in HRV and 123-I MIBG scintigraphy were seen in patients who underwent ablation of left lateral accessory pathways. We conclude that radiofrequency ablation in the anterior, mid-, and posterior regions of the low intraatrial septum may disrupt sympathetic fibers located in these regions, causing cardiac sympathetic denervation. The density of these fibers appear to be less along the left atrioventricular groove.
射频消融术后曾有不适当窦性心动过速和房性心律失常的报道。既往研究提示心脏去神经支配可能是这些节律紊乱的一种解释。本研究的目的是运用心率变异性（HRV）分析和间碘苄胍（I-123 MIBG）闪烁显像技术，调查消融术后心脏自主神经支配可能发生的改变。本研究的对象为30例年龄在25至40岁之间、无结构性心脏病的连续患者，他们因有症状的复发性折返性心动过速而接受了房室结慢径路、后间隔及左侧旁道的射频消融。与房室结慢径路消融组患者消融前的值相比，消融后HRV的时域和频域分析显示RR间期所有5分钟标准差的平均值（p = 0.042）、低频（p = 0.0005）和总频率（p = 0.008）指标显著降低。接受后间隔旁道消融的患者，RR间期平均值的标准差（p = 0.03）、5分钟RR间期平均值的标准差（p = 0.006）以及低频（p <0.0001）和高频（p <0.0001）成分的指标也有显著衰减。在同一组患者中还发现了显著的I-123 MIBG图像缺损，提示心脏传出交感神经去神经支配：房室结组（p = 0.0024）、后间隔旁道组（p = 0.0007）。接受左侧旁道消融的患者未出现上述HRV和123-I MIBG闪烁显像的变化。我们得出结论，低位房间隔前部、中部和后部区域的射频消融可能会破坏位于这些区域的交感神经纤维，导致心脏交感神经去神经支配。这些纤维的密度似乎沿左房室沟处较低。
