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目的研究肺静脉隔离(PVI)对犬的心房迷走神经功能及心房颤动(简称房颤)易感性的影响。方法9条成年杂种犬,全麻下行颈交感-迷走神经干剥离术。静脉应用美托洛尔阻断交感神经活性。分别于肺静脉消融前后在基础状态及迷走神经刺激时测量窦性周长(SCL)、右心耳(RAA)、左心耳(LAA)、冠状静脉窦近端(CSp)和冠状静脉窦远端(CSd)的不应期(ERP)及心房易感窗口(VW)。结果①PVI前迷走神经刺激能明显降低SCL(P<0.001),PVI后迷走神经刺激对SCL影响较小(P>0.05)。②PVI前,迷走神经刺激能明显缩短心房各部位ERP(P均<0.05)。PVI后,迷走神经刺激对心房ERP的影响较小(P均>0.05)。③PVI前后基础状态下测得的VW无变化。PVI后迷走神经介导的房颤诱发率明显下降(P均<0.05)。结论PVI能导致迷走神经介导的窦房结抑制、心房不应期缩短能力及房颤易感窗口增加能力明显下降。
Objective To investigate the effect of pulmonary vein isolation (PVI) on atrial vagal nerve function and susceptibility to atrial fibrillation (AF) in dogs. Methods Nine adult mongrel dogs underwent cervical sympathetic-vagotomy under general anesthesia. Intravenous metoprolol blocks sympathetic activity. (SCL), right atrial appendage (RAA), left atrial appendage (LAA), coronary sinus proximal (CSp) and distal coronary sinus (CSd) were measured before and after pulmonary vein ablation in basal state and vagus nerve stimulation Response (ERP) and atrial susceptibility window (VW). Results ① Before vagal stimulation of PVI, the SCL was significantly decreased (P <0.001). The vagus nerve stimulation had less effect on SCL after PVI (P> 0.05). ②PVI before vagus nerve stimulation can significantly shorten the atrial ERP (P all <0.05). After PVI, vagal stimulation had little effect on atrial ERP (all P> 0.05). ③ PVI before and after the baseline state measured no change in VW. After PVI vagus nerve-mediated atrial fibrillation induced rate was significantly decreased (P all <0.05). Conclusion PVI can lead to vagal nerve-mediated inhibition of sinoatrial node, shortening of atrial refractory period and increasing susceptibility to atrial fibrillation.