CAJ | 학술논문

目的探讨低强度脊髓神经刺激(SCS)对6h快速心房起搏(6 h-RAP)导致的心房急性电重构的影响.方法 12只体重15 ～20 kg的正常成年杂种犬麻醉后开胸暴露心脏,在左右心房、左右肺静脉和左心耳(LAA)缝置电极导线用以记录和刺激.通过LAA电极以1 200次/min,2倍的舒张期起搏阈值进行6 h-RAP建立心房急性电重构的模型.所有的犬随机分为2组:实验组6只,在6 h-RAP同时选择T1-T2节段脊髓硬膜外区进行低强度的SCS;对照组6只,选择T1-T2节段体表的皮肤给予类似的6h低强度刺激.分别在基础状态和每2h末测定心房和肺静脉各部位的有效不应期(ERP)和心房颤动(房颤)的诱发窗口(WOV).结果与基础状态相比:对照组(6 h-RAP+皮肤刺激)心房和肺静脉各部位的ERP逐渐缩短(所有P＜0.05),ERP离散度和房颤总的WOV逐渐延长(P＜0.05);实验组(6 h-RAP+6 h-SCS)除左上肺静脉ERP无明显改变外(P＞0.05),其他部位ERP均显著延长,差异有统计学意义(P＜0.05),ERP离散度和房颤总的WOV没有显著性改变(P＞0.05).结论低强度SCS能够抑制由6 h-RAP引起的心房急性电重构.
목적 탐토저강도척수신경자격(SCS)대6h쾌속심방기박(6 h-RAP)도치적심방급성전중구적영향.방법 12지체중15 ～20 kg적정상성년잡충견마취후개흉폭로심장,재좌우심방、좌우폐정맥화좌심이(LAA)봉치전겁도선용이기록화자격.통과LAA전겁이1 200차/min,2배적서장기기박역치진행6 h-RAP건립심방급성전중구적모형.소유적견수궤분위2조:실험조6지,재6 h-RAP동시선택T1-T2절단척수경막외구진행저강도적SCS;대조조6지,선택T1-T2절단체표적피부급여유사적6h저강도자격.분별재기출상태화매2h말측정심방화폐정맥각부위적유효불응기(ERP)화심방전동(방전)적유발창구(WOV).결과 여기출상태상비:대조조(6 h-RAP+피부자격)심방화폐정맥각부위적ERP축점축단(소유P＜0.05),ERP리산도화방전총적WOV축점연장(P＜0.05);실험조(6 h-RAP+6 h-SCS)제좌상폐정맥ERP무명현개변외(P＞0.05),기타부위ERP균현저연장,차이유통계학의의(P＜0.05),ERP리산도화방전총적WOV몰유현저성개변(P＞0.05).결론 저강도SCS능구억제유6 h-RAP인기적심방급성전중구.
Objective To investigate the effects of low-level spinal cord stimulation (SCS) on atrial acute electrical remodeling induced by 6 hours rapid atrial pacing (6 h-RAP).Methods In twelve anesthetized open-chest dogs,multi-electrode catheters were sutured to multiple sites to allow recording and stimulating at the left atrial appendage (LAA),left and right atrium,left and right pulmonary veins.Atrial acute electrical remodeling was induced by 6 h-RAP (1 200 beat/min,2×threshold) at LAA.Low-level SCS was applied at the dorsal T1-T2 segments of the spinal cord (at 50 Hz,0.2 ms) for 6 hours in 6 dogs.The similar low-level stimulation was delivered to the skin nearby the dorsal T1-T2 segments of the spinal cord in another 6 dogs as control.The atrial effective refractory period (ERP) and the window of vulnerability (WOV) for AF were measured at all recording sites at baseline and at the end of each two hours during 6 h-RAP.Results In the control group (6 h-RAP+skin stimulation):ERP was significantly shortened at each site (P＜0.05 for all) and the total WOV and ERP dispersion were significantly increased (P＜0.05 for all) compared to the baseline respectively.Comparing to the baseline values,6 h-RAP plus 6 h-SCS (1) did not significantly alter ERP at left superior pulmonary vein (P＞0.05) and significantly prolonged ERP at other five sites (P＜0.05 for all) ;(2) did not significantly change the total WOV and ERP dispersion (P＞0.05 for all).Conclusion Low-level SCS can suppress atrial acute electrical remodeling induced by 6 h-RAP.