射频消融术后心脏自主神经的变化对房颤早期复发的影响

目的:通过心率变异性分析,探讨左房环肺静脉消融术对自主神经系统的影响及其与心房颤动(房颤)早期复发的关系。方法:阵发性房颤患者90例,均接受CARTO指导下左房环肺静脉电隔离射频消融术。在术前3 d及术后3 d进行12导联动态心电图(Holter)监测,根据术后随访结果将患者分为房颤复发组(n=38例)和无复发组(n=52例)。并记录两组的平均心率(MeanHR),心率变异性(heart rate variability,HRV)分析,包括时域指标SDNN、SDANN、rMSSD、PNN50,频域指标W、LF、HF、LF/HF,进行比较。结果:90例患者均达到肺静脉电隔离。术后反应迷走神经及交感神经张力的指标均显著降低;在无复发组,反应迷走神经张力的HF降低更显著,LF/HF升高,其它HRV指标均显著降低;在复发组,MeanHR升高,反应交感神经张力的LF显著降低,LF/HF降低。结论:降低迷走神经张力,可能会抑制阵发性房颤患者左房环肺静脉消融术后的早期复发。

Influence of autonomic nerve system on early recurrence of atrial fibrillation after radiofrequency ablation of paroxysmal atrial fibrillation

AIM: To investigate the relationship between autonomic nervous system(ANS) and early recurrence of atrial fibrillation(AF) after left atrium circumferential pulmonary vein ablation.METHODS: A total of 90 patients with paroxysmal AF underwent circumferential pulmonary vein ablation using CARTO system.All patients underwent 24-h ambulatory Holter monitoring and heart rate variability(HRV) analysis 3 days before and after the ablation.Patients were divided into recurrence group(n=38) and non-recurrence group(n=52) based on the postoperative Holter results,symptoms and electrocardiogram.The average heart rate(mean HR),time domain indexes(such as SDNN,SDANN,rMSSD,PNN50) and frequency domain index(such as W,LF,HF,LF/HF) of the two groups were compared.RESULTS: Electrical isolation of the pulmonary veins was achieved in all 90 patients.The parameters indicated parasympathetic and sympathetic activities decreased significantly after ablation in both groups.In non-recurrence group,indictors of parasympathetic tone were significantly lower,whereas those of sympathetic tone were higher in recurrence group.CONCLUSIONS: Vagal denervation may inhibit early recurrence of AF after left atrium circumferential pulmonary vein ablation in patients with paroxysmal AF.