CAJ | 학술논문

目的近期研究认为富含浦肯野纤维的左心室后乳头肌存在明显的心电不均一性,可能是心室颤动(室颤)发生与维持的重要区域.本实验探索以经皮导管乙醇消融左心室后乳头肌,破坏致心律失常基质,从而预防和治疗室颤的可行性.方法 13只猪麻醉后,行双侧股动、静脉穿刺,置入鞘管及标测导管.后乳头肌消融术前,所有动物均以程序期前刺激诱发室颤.在经超声心动图和X线引导下,将微导管连同0.014 s导丝通过导引导管刺入左心室后乳头肌,撤出导丝,通过微导管中心腔注射无水乙醇(消融组6只)或生理盐水(对照组6只)1～1.5 ml,实施后乳头肌化学消融.结果后乳头肌微导管刺入后,1只猪死于心脏压塞,12只猪完成经皮导管注射术.消融组1只诱发出持续室颤(1/6),对照组6只均诱发出室颤(6/6),左心室后乳头肌经皮导管乙醇消融术后持续性室颤的诱发率明显减低(P＜0.01).结论对正常猪在体心脏左心室后乳头肌基底部乙醇消融可以降低程序期前刺激诱发的室颤的几率.左心室后乳头肌可能是室颤发生与维持的重要致心律失常基质.
목적 근기연구인위부함포긍야섬유적좌심실후유두기존재명현적심전불균일성,가능시심실전동(실전)발생여유지적중요구역.본실험탐색이경피도관을순소융좌심실후유두기,파배치심률실상기질,종이예방화치료실전적가행성.방법 13지저마취후,행쌍측고동、정맥천자,치입초관급표측도관.후유두기소융술전,소유동물균이정서기전자격유발실전.재경초성심동도화X선인도하,장미도관련동0.014 s도사통과도인도관자입좌심실후유두기,철출도사,통과미도관중심강주사무수을순(소융조6지)혹생리염수(대조조6지)1～1.5 ml,실시후유두기화학소융.결과 후유두기미도관자입후,1지저사우심장압새,12지저완성경피도관주사술.소융조1지유발출지속실전(1/6),대조조6지균유발출실전(6/6),좌심실후유두기경피도관을순소융술후지속성실전적유발솔명현감저(P＜0.01).결론 대정상저재체심장좌심실후유두기기저부을순소융가이강저정서기전자격유발적실전적궤솔.좌심실후유두기가능시실전발생여유지적중요치심률실상기질.
Objectives The exact mechanism of ventricular fibrillation (VF) is still uncertain.According to current research,left ventricular posterior papillary muscle (PPM) is rich in purkinje fiber with significant transmembrane dispersion of repolarization.Hence,they could be the critical site of initiation and maintenance of VF.This research tries to electrically isolate PPM by percutaneous catheter alcohol ablation,to prevent and treat VF by destroying the arrhythmic substrate of VF.Methods Thirteen anesthetized swine underwent both femoral artery and femoral vein puncture,as well as sheath insertion.Before PPM ablation,VF was induced by programmed extra RV stimulation in each animal.Under the guidance of transthoracic echocardiography and fluoroscopy,a micro-catheter with a stiff 0.014 inch guide wire (supported by a transaortic guiding catheter) were punctured into the PPM.After the guide wire was withdrawn,chemical ablation was performed by injecting dehydrated alcohol ( ablation group,n =6) or saline ( control group,n =6) into the base of PPM through the central lumen of the micro-catheter.Results After PPM puncture,One animal was dead due to cardiac tamponade,twelve animals were performed percutaneous trans-catheter injection.In ablation group,no VF were induced by programmed RV stimulation in three animals (3/6) and two of them had no VF induced by further RV extra pacing either; two animals (2/6) had induced nonsustained VF and self terminated in several seconds; one animal (1/6) had induced sustained VF.In control group,all six animals (6/6) had induced sustained VF.The inducibility of sustained VF was significantly reduced by percutaneous catheter alcohol ablation on posterior papillary muscle (P＜0.01 ).Conclusion Percutaneous catheter alcohol ablation of the left ventricular PPM could reduce VF inducibility in normal intact swine hearts.This suggests that the PPM may be involved in the generation and maintenance of VF.