JAHA:肺静脉隔离术后自主神经功能改变

2021-02-27 MedSci原创 MedSci原创

肺静脉隔离导致与自主神经功能有关的心率指标持续显著变化。这些变化与手术结局相关,并且与所使用的消融技术无关。

经导管消融治疗难治性阵发性房颤后自主神经改变的自然病史尚未明确,这很大程度上是因为过去依赖无创间歇性心率监测设备来确定患者结局。

近日,血管疾病领域权威杂志JAHA上发表了一篇研究文章,该研究纳入了346名使用当代先进的消融技术进行肺静脉隔离的难治性阵发性房颤患者。所有患者在消融前均需插入Reveal LINQ(Medtronic)植入式心脏监护仪。

研究人员通过植入式心脏监护仪连续记录受试者身体活动、心率变异性、白天心率和夜间心率。研究人员比较了受试者在消融日期之前2个月内的纵向自主神经数据与消融后91到365天之间的纵向自主神经数据。

消融后,心率变异性显著下降(与基线的平均差为19.3 ms;范围为12.9-25.7;P<0.0001),白天和夜间心率显著增加(与基线的平均差为9.6 bpm;范围为7.4-11.8;P<0.0001和7.4 bpm;范围为5.4-9.3;P<0.0001)。相比于心律失常复发的患者,无心律失常复发的患者白天(11±11 vs. 8±12 bpm,P= 0.001)和夜间心率(8±9 vs. 6±8 bpm,P=0.049)明显较快,但心率变异性没有差异(P=0.09)。消融技术和冷冻消融持续时间不影响这些自主神经系统的效应。

由此可见,肺静脉隔离导致与自主神经功能有关的心率指标持续显著变化。这些变化与手术结局相关,并且与所使用的消融技术无关

原始出处:

Lisa Y. W. Tang.et al.Autonomic Alterations After Pulmonary Vein Isolation in the CIRCA‐DOSE (Cryoballoon vs Irrigated Radiofrequency Catheter Ablation) Study.J AM HEART ASSOC.2021.https://www.ahajournals.org/doi/10.1161/JAHA.120.018610

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    2021-08-24 fusion
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    2021-03-01 zhaohui6731
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