自主神经及射频消融术后房颤早期发作的关系.doc

自主神经与射频消融术后房颤早期发作的E-mail: hsq8593@163.com *通信作者(Corresponding author).Tel: 021E-mail: [摘要] 目的 潜水反射试验、冷加压试验评估射频消融术后自主神经调控强度房颤早期发作的。方法102例阵发性房颤术前后分别行潜水反射试验、冷加压试验，观察心率变化与房颤早期发作的关系。结果 潜水反射试验使患者心率减慢，而冷加压试验使心率加快房颤射频消融术后，患者（P0.05）（P0.05）。术后房颤早期发作的患者，潜水反射强度高（P0.05）。结论 阵发性房颤射频消融术后迷走反射强度减弱，术后房颤的早期发作。 [关键词] 心房颤动 潜水反射 冷加压试验 自主神经Abstract] Objective: To investigate the relationship between autonomic nervous reflex and early recurrence of atrial fibrillation after radiofrequency catheter ablation (RFCA), according to diving reflex test and cold pressor test. Methods: A total of 102 patients with paroxysmal atrial fibrillation were recruited. All patients underwent diving reflex test and cold pressor test before and after RFCA. The average heart rate was compared and its relationship with early recurrence of atrial fibrillation. Results: Circumferential pulmonary vein isolation was achieved in all 102 patients. Average heat rate was decreased and increased respectively by diving reflex test and cold pressor tes (P0.05). Diving reflex decreased significantly after RFCA (P0.05). Diving reflex was more powerful in patients with early recurrence of atrial fibrillation than without (P0.05). Conclusion: Parasympathetic activity decreases after RFCA as evaluated by diving reflex test, which may be related with early recurrence of atrial fibrillation. Key words: atrial fibrillation; diving reflex; cold pressor test; autonomic nervous system 众多动物及临床研究表明自主神经的调控与房颤的发生、发展密切[1-3] ，射频消融术对房颤患者自主神经的影响成为近年来研究的热点之一。潜水反射试验、冷加压试验广泛应用于临床。旨在潜水反射试验、冷加压试验评估射频消融术自主神经调控强度后房颤早期发作的。 病例资料 2012年7月至2013年6月于第二军医大学长海医院心内科行射频消融术的阵发性房颤患者102例，其中男性67例，女性35例，年龄2979岁±10.09岁）。排除标准： 方法 潜水反射试验 患者平卧休息10，行心电监护，记录，嘱患者屏气后将面部浸入水中，[1]，记录，30后试验结束。间隔3后再次检测，共3次取平均值。 冷加压试验 患者平卧休息10，行心电监护，记录嘱患者双手张开并浸入水中，[1]，水面没过手腕，记录，持续0 s后试验结束。间隔3后再次检测，共3次取平均值。 射频消融 消毒穿刺点皮肤，穿刺左侧股静脉，置入10极冠状窦电极及4极右室电极。穿刺右侧股静脉，行房间隔穿刺，置入2根Swarts鞘管，将冷盐水消融电极及环状电极置入左房，采用EnsiteNavX三维标测系统构建左房电解剖图。设置功率2530 W，温度43，流量17 mL/min，采用冷盐水消融电极行双侧环肺静脉电隔离术，环状电极置于肺静脉内确认双