导管消融去肾交感神经抑制星状神经节刺激诱发的心房颤动

【目的】探讨经导管射频消融去肾交感神经对交感神经过度激活介导的心房颤动的影响和心房电重构机制?【方法】 16只家犬随机分为对照组(n = 8)和去肾交感神经(RSD)组(n = 8),RSD组进行经导管射频消融去肾交感神经术,对照组行不消融肾交感神经的假手术,通过左侧星状神经节电刺激(LSG) +快速心房起搏(RAP)3 h建立交感神经介导的房颤犬模型?【结果】 LSG刺激联合RAP使左心耳?右心房?左上肺静脉?左下肺静脉部位的房颤诱发率升高,有效不应期缩短(ERP),有效不应期离散度增大,均较基础值有统计学差异(P < 0.05),RSD组消融后各部位房颤诱发率降低?ERP显著延长?ERP离散度显著缩小,与对照组相比有统计学差异(P < 0.05)?LSG刺激联合RAP引起各检测部位的R-R间期?SDNN缩短,LF?HF和LF/HF降低,均较基础值有统计学差异(P < 0.05);RSD可逆转LSG刺激联合RAP引起的这些心率变异性改变,与对照组相比具有统计学差异(P < 0.05)?【结论】 交感神经过度激活使房颤易于诱发?恶化急性心房电重构,RSD可有效降低房颤的诱发率,抑制心房电重构?改善心脏自主神经功能,提示RSD对交感神经过度激活介导的房颤的发生具有潜在抑制作用?

Catheter-based Renal Sympathetic Denervation Significantly Inhibits Atrial Fibrillation Induced by Electrical Stimulation of Left Stellate Ganglion and Rapid Atrial Pacing

【Objective】 The aim of this study was to identify the effects of renal sympathetic denervation (RSD) on AF inducibility induced by hyper-sympathetic activity in a canine model. 【Methods】 The sixteen dogs were divided into control group (n = 8) and RSD group (n = 8); The control group underwent sham-operation without renal sympathetic nerve ablation. The RSD group underwent catheter-based radiofrequency ablation of the renal sympathetic nerve. To establish a canine model of AF mediated by excessive sympathetic activity, sixteen dogs were subjected to stimulation of left stellate ganglion (LSG) combined with rapid atrial pacing (RAP) for 3 hours. 【Results】 LSG stimulation combined RAP significantly induced an increase in AF induction rate, a shorten in ERP, an increase in ERP dispersion at all sites examined (P < 0.05 in all values). The increased AF induction rate, shortened ERP and increased ERP dispersion can be almost reversed by RSD, compared to the control group (P < 0.05). LSG stimulation combined RAP markedly shortened RR-interval and standard deviation of all RR-intervals (SDNN), Low-frequency (LF), high-frequency (HF) and LF/HF ratio (P < 0.05). These changes can be reversed by RSD, compared to the control group (P < 0.05). 【Conclusions】 Hyper-sympathetic activity may facilitate the initiation of AF and acute atrial electrophysiological changes. RSD significantly reduced AF inducibility and reversed the atrial electrophysiological changes induced by hyper-sympathetic activity. Our findings suggest that RSD has a potent inhibitory effect on AF inducibility induced by hyper-sympathetic nerve activity.