中华心律失常学杂志
中華心律失常學雜誌
중화심률실상학잡지
CHINESE JOURNAL OF CARDIAC ARRHYTHMIAS
2009年
6期
445-449
,共5页
曾红%贺玉泉%柳林%杨萍
曾紅%賀玉泉%柳林%楊萍
증홍%하옥천%류림%양평
自主神经系统%心房颤动%窦房结%心脏电生理
自主神經繫統%心房顫動%竇房結%心髒電生理
자주신경계통%심방전동%두방결%심장전생리
Autonomic nervous system%Atrial fibrillation%Sinoatrial node%Cardiac electrophysiology
目的 位于右心房及右肺静脉交界处的窦房结(SAN)脂肪垫含有丰富的支配心房的副交感神经纤维节.本实验通过选择性直接刺激心脏SAN脂肪垫,观察其对SAN功能、房室传导、心房有效不应期(AERP)及心室有效不应期(VERP)、心房颤动(AF)诱发易感性等电生理参数的影响,以明确心房SAN脂肪垫的副交感神经功能分布特点及探讨AF发生机制.方法 入选杂种犬33只,右侧开胸暴露SAN脂肪垫.将标准的电生理导管置于右心房、希氏束、右心窒心尖部及右心室流出道,记录基础窦性周期长度(SCL)、AH及HV间期、房室结文氏点、AERP及VERP、AF诱发窗口(WOV)及快速右心房起搏诱发AF的RR间期.以逐级递增的能量直接刺激SAN脂肪垫直至AF诱发,测定不同能量状态下SCL及AF诱发阈值.以引起SCL较基线延长50%的固定能量再次刺激SAN脂肪垫,观察其对上述电生理参数的影响.AF诱发成功后,继续逐级增加刺激能量直至最人值10.0 mA.记录不同能量状态下诱发AF的连续10个RR间期,取其平均值.结果 100%犬在直接SAN脂肪垫刺激下诱发AF,AF诱发阈值为(4.0±1.3)mA.AF诱发前,SAN脂肪垫刺激导致窦性心率减慢[SCL:(588±77)ms对(994±293)ms,P<0.001].AF诱发后,直接刺激诱导AF RR间期进行性延长[(461±204)ms对最长(636±260)ms,P<0.001],个别犬出现高度房室阻滞.在以延艮SCL 50%的固定能量刺激SAN脂肪垫时,AERP与刺激前比较明显缩短(P<0.001)、WOV增宽(P<0.001),而AH、HV、房室结文氏点、VERP无变化(P>0.05).结论 直接SAN脂肪垫刺激延长SCL,缩短AERP,增加AF诱发易感性,而对房窒结下区传导及心室无影响.以前文献报道SAN脂肪垫只有单一调节SAN的功能,而本实验结果显示当刺激能量足够时,SAN脂肪垫还町减慢AF时房窜传导.
目的 位于右心房及右肺靜脈交界處的竇房結(SAN)脂肪墊含有豐富的支配心房的副交感神經纖維節.本實驗通過選擇性直接刺激心髒SAN脂肪墊,觀察其對SAN功能、房室傳導、心房有效不應期(AERP)及心室有效不應期(VERP)、心房顫動(AF)誘髮易感性等電生理參數的影響,以明確心房SAN脂肪墊的副交感神經功能分佈特點及探討AF髮生機製.方法 入選雜種犬33隻,右側開胸暴露SAN脂肪墊.將標準的電生理導管置于右心房、希氏束、右心窒心尖部及右心室流齣道,記錄基礎竇性週期長度(SCL)、AH及HV間期、房室結文氏點、AERP及VERP、AF誘髮窗口(WOV)及快速右心房起搏誘髮AF的RR間期.以逐級遞增的能量直接刺激SAN脂肪墊直至AF誘髮,測定不同能量狀態下SCL及AF誘髮閾值.以引起SCL較基線延長50%的固定能量再次刺激SAN脂肪墊,觀察其對上述電生理參數的影響.AF誘髮成功後,繼續逐級增加刺激能量直至最人值10.0 mA.記錄不同能量狀態下誘髮AF的連續10箇RR間期,取其平均值.結果 100%犬在直接SAN脂肪墊刺激下誘髮AF,AF誘髮閾值為(4.0±1.3)mA.AF誘髮前,SAN脂肪墊刺激導緻竇性心率減慢[SCL:(588±77)ms對(994±293)ms,P<0.001].AF誘髮後,直接刺激誘導AF RR間期進行性延長[(461±204)ms對最長(636±260)ms,P<0.001],箇彆犬齣現高度房室阻滯.在以延艮SCL 50%的固定能量刺激SAN脂肪墊時,AERP與刺激前比較明顯縮短(P<0.001)、WOV增寬(P<0.001),而AH、HV、房室結文氏點、VERP無變化(P>0.05).結論 直接SAN脂肪墊刺激延長SCL,縮短AERP,增加AF誘髮易感性,而對房窒結下區傳導及心室無影響.以前文獻報道SAN脂肪墊隻有單一調節SAN的功能,而本實驗結果顯示噹刺激能量足夠時,SAN脂肪墊還町減慢AF時房竄傳導.
목적 위우우심방급우폐정맥교계처적두방결(SAN)지방점함유봉부적지배심방적부교감신경섬유절.본실험통과선택성직접자격심장SAN지방점,관찰기대SAN공능、방실전도、심방유효불응기(AERP)급심실유효불응기(VERP)、심방전동(AF)유발역감성등전생리삼수적영향,이명학심방SAN지방점적부교감신경공능분포특점급탐토AF발생궤제.방법 입선잡충견33지,우측개흉폭로SAN지방점.장표준적전생리도관치우우심방、희씨속、우심질심첨부급우심실류출도,기록기출두성주기장도(SCL)、AH급HV간기、방실결문씨점、AERP급VERP、AF유발창구(WOV)급쾌속우심방기박유발AF적RR간기.이축급체증적능량직접자격SAN지방점직지AF유발,측정불동능량상태하SCL급AF유발역치.이인기SCL교기선연장50%적고정능량재차자격SAN지방점,관찰기대상술전생리삼수적영향.AF유발성공후,계속축급증가자격능량직지최인치10.0 mA.기록불동능량상태하유발AF적련속10개RR간기,취기평균치.결과 100%견재직접SAN지방점자격하유발AF,AF유발역치위(4.0±1.3)mA.AF유발전,SAN지방점자격도치두성심솔감만[SCL:(588±77)ms대(994±293)ms,P<0.001].AF유발후,직접자격유도AF RR간기진행성연장[(461±204)ms대최장(636±260)ms,P<0.001],개별견출현고도방실조체.재이연간SCL 50%적고정능량자격SAN지방점시,AERP여자격전비교명현축단(P<0.001)、WOV증관(P<0.001),이AH、HV、방실결문씨점、VERP무변화(P>0.05).결론 직접SAN지방점자격연장SCL,축단AERP,증가AF유발역감성,이대방질결하구전도급심실무영향.이전문헌보도SAN지방점지유단일조절SAN적공능,이본실험결과현시당자격능량족구시,SAN지방점환정감만AF시방찬전도.
Objective Parasympathetic innervations of atrium can be selectively stimulated via sinoatrial nodal (SAN) fat pad located at the junction of right atrium (RA) and right pulmonary vein. This study was de signed to evaluate the electrophysiological response of SAN, atrioventricular conduction, atrial (AERP) and ventricular effective refractory period (VERP),and atrial fibrillation (AF) inducibility in response to direct SAN fat pad stimulation. Methods In 33 adult mongrel dogs,via right lateral thoracotomy,SAN fat pad was di rectly stimulated. EP catheters were placed in RA, His bundle, right ventricular apex and right ventricular out flow tract Baseline sinus cycle length (SCL),AH and HV intervals, A V node Wenckebach point, AERP, VERP, window of vulnerability (WOV) and RR intervals during AF induced by rapid RA pacing were tested. Under SAN fat pad stimulation with stepwise incremental stimulation energy, SCL and AF threshold were recor ded until AF induction. With the stimulation energy at inducing 50% prolongation in SCL,SAN fat pad was re stimulated and the above-mentioned EP parameters were re-tested. After AF was successfully induced, the stim ulation energy was continually increased stepwise until maximum 10.0 mA. Successive 10 RR intervals during stimulus-induced AF with various stimulation current settings were recorded and averaged. Results 100% animals were repeatedly induced AF by SAN fat pad stimulation. The AF threshold was (4. 0 ± 1. 3)mA. Before AF induction, SAN fat pad stimulation prolonged SCL from (588 ± 77) ms to (994 ± 293) ms (P<0. 001). After AF induction, SAN fat pad stimulation produced graded prolongation of RR during AF((461 ±204)ms vs. Max (636 ±260)ms,P<0. 001],and even led to complete atrioventricular block in one animals. During stimulation at fixed energy inducing 50% prolongation in SCL, AERP was shortened (P <0. 001) and VOW was widened,but no obvious change was found in AH,HV,AV node Wenckebach point,and VERP(P=NS). Conclusion Direct SAN fat pad stimulation prolonged SCL, shortened AERP and increased AF inducibility which had no effect on HV and VERP. Our data also showed that SAN fat pad retarded atrioventricular conduction with AF when the stimulation was high enough.
