摘要
目的:探讨血管迷走性晕厥合并频发室性早搏(室早)患者自主神经调控对室早发生的影响,并评估射频导管消融治疗此类室早的临床价值。方法:连续入选血管迷走性晕厥合并频发室早的患者20例。基线时采集24 h动态心电图数据,行心率减速力检测和室早分析,以心率减速力定量评估心脏迷走神经张力,分析室早负荷同心率减速力、平均心率和心率变异性指标的相关性。根据每小时室早负荷同心率减速力的相关性,将患者分为减速力相关室早组(D-PVC组,n=14)和减速力无关室早组(I-PVC组,n=6)。20例患者均接受左心房自主神经节丛(GP)消融,其中16例同时行室早消融,术后再次评估室早负荷及心率减速力。结果:D-PVC组患者室早负荷同心率减速力呈正相关(P<0.05),同平均心率呈负相关(P<0.05),而I-PVC组患者室早负荷同心率减速力、平均心率及心率变异性指标均不相关(P均>0.05)。20例患者标测并消融了39个呈阳性反应的GP,平均每例患者(1.9±0.9)个阳性GP。4例患者术中无室早,故未行室早的标测和消融治疗,其余16例患者经电生理检查证实室早均起源于流出道,其中15例为右心室流出道间隔部起源,1例为左冠窦起源。射频导管消融治疗室早的即刻成功率为100%,平均随访(8.6±4.5)个月,晕厥复发1例,室早复发1例,未出现介入治疗相关并发症。术后1个月随访结果显示,所有患者的心率减速力指标较术前显著减低(P<0.001),仅接受左心房GP消融且术后未应用抗心律失常药物的4例患者室早负荷同基线相比显著降低(P=0.040)。结论:自主神经调控在部分血管迷走性晕厥合并室早患者中影响了室早的发生和维持,迷走神经兴奋性增加时心率减速力相关室早患者的室早出现更加频繁,选择射频导管消融治疗安全有效。
Objectives: To evaluate the autonomic modulation and effects of catheter ablation of symptomatic ventricular arrhythmia in patients with vasovagal syncope(VVS).Methods: Twenty consecutive symptomatic premature ventricular contractions(PVCs) patients with concomitant vasovagal syncope(VVS) were enrolled. 24 h Holter ECG was performed at baseline and one month post-ablation of PVCs, from which data of deceleration capacity(DC) and PVC occurrence were obtained and patients were divided into DCdependent(D-PVC group, n=14) and DC-independent(I-PVC group, n=6). According to the correlation between hourly PVC burden and hourly DC at baseline. The association between hourly PVC burden and hourly DC, heart rate and HRV indices were analyzed. Left atrial ganglionated plexis(GP) ablation was performed for all patients. Electrophysiological mapping and catheter ablation of ventricular arrhythmia were performed for 16 patients during GP ablation. Results: In D-PVC patients, circadian rhythm of hourly PVC burden was positively correlated with that of hourly DC, negatively correlated with mean heart rate(P<0.05). In I-PVC patients, there was no correlation among circadian rhythm, hourly PVC and mean heart rate(P>0.05). Thirty-nine GP with positive vagal response(1.9±0.9/patient) were located and ablated. Catheter ablation of ventricular arrhythmias achieved acute success in all sixteen cases(15 originating from right ventricular outflow tract, 1 from left aortic sinus). Post-ablation DC parameters decreased significantly compared with baseline level(P all<0.05). During a mean(8.6 ± 4.5) months follow-up, syncope reoccurred in one patient and recurrent PVCs were documented in one patient. There were no procedure-related complications during follow up. Interestingly, significant decrease of PVC burden was observed during follow-up in the four patients in whom neither catheter ablation nor antiarrhythmic drugs were applied(P=0.040). Conclusions: Autonomic activities are involved in the occurrence of symptomatic PVCs in VVS patie
作者
孙巍
郑黎晖
乔宇
侯炳波
吴灵敏
郭金锐
姚焰
SUN Wei;ZHENG Li-hui;QIAO Yu;HOU Bing-bo;WU Lin-min;GUO Jin-rui;YAO Yan(Arrhythmia Center,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing (100037),China)
出处
《中国循环杂志》
CSCD
北大核心
2018年第12期1208-1213,共6页
Chinese Circulation Journal
基金
国家重点研发计划(2017YFC1307800).
关键词
血管迷走性晕厥
室性早搏
心率减速力
射频导管消融
Vasovagal syncope
Ventricular arrhythmia
Deceleration capacity
Catheter ablation
