桑才华,孙莉萍,董建增,白融,李松南,龙德勇,喻荣辉,汤日波,蒋晨曦,刘念,郭雪原,闻松男,宁曼,杜昕,马长生

• 1:首都医科大学附属北京安贞医院心内科

摘要(Abstract)：

目的在心房颤动(房颤)冷冻球囊消融术中,消融肺静脉经常诱发迷走反射。本研究旨在评估预注射阿托品对此迷走反射的作用。方法连续入选25例接受冷冻球囊消融术的阵发性房颤患者,前12例为试验组,后13例为对照组。试验组在冷冻球囊回缩前静推1 mg阿托品,对照组仅在血流动力学变化[心率和(或)血压降低]开始后给予阿托品,血流动力学变化恢复,即定义为治疗有效。结果试验组中,3例血压一过性降低,无需治疗;1例发生低血压,需要支持治疗。对照组中,分别有6例低血压、3例心动过缓和3例混合性心动过缓-低血压。预注射阿托品可使术中迷走反射发生率显著降低(4/12比12/13,P<0.01)。结论预注射阿托品可预防房颤冷冻球囊消融术中的迷走反射。

关键词(KeyWords)： 血管迷走反射;阿托品;心房颤动;冷冻球囊

Abstract:

Keywords:

基金项目(Foundation): 北京市博士后基金支持(2015ZZ-64)

作者(Author): 桑才华,孙莉萍,董建增,白融,李松南,龙德勇,喻荣辉,汤日波,蒋晨曦,刘念,郭雪原,闻松男,宁曼,杜昕,马长生

参考文献(References)：

• [1]Sarabanda AV,Bunch TJ,Johnson SB,et al.Efficacy and safety of circumferential pulmonary vein isolation using a novel cryothermal balloon ablation system.J Am Coll Cardiol,2005,46(10):1902-1912.
• [2]Pappone C,Santinelli V,Manguso F,et al.Pulmonary vein denervation enhances long-term benefit after circumferential ablation for paroxysmal atrial fibrillation.Circulation,2004,109(3):327-334.
• [3]Oswald H,Klein G,Koenig T,et al.Cryoballoon pulmonary vein isolation temporarily modulates the intrinsic cardiac autonomic nervous system.J Interv Card Electrophysiol,2010,29(1):57-62.
• [4]Miyazaki S,Nakamura H,Taniguchi H,et al.Impact of the order of the targeted pulmonary vein on the vagal response during second-generation cryoballoon ablation.Heart Rhythm,2016,13(5):1010-1017.
• [5]Calkins H,Hindricks G,Cappato R,et al.2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation.Heart Rhythm,2017[Epub ahead of print].
• [6]Sheldon RS,Grubb BP 2nd,Olshansky B,et al.2015 heart rhythm society expert consensus statement on the diagnosis and treatment of postural tachycardia syndrome,inappropriate sinus tachycardia,and vasovagal syncope.Heart Rhythm,2015,12(6):e41-e63.
• [7]Miyanaga S,Yamane T,Date T,et al.Impact of pulmonary vein isolation on the autonomic modulation in patients with paroxysmal atrial fibrillation and prolonged sinus pauses.Europace,2009,11(5):576-581.
• [8]Sutton R.Is there an effective pharmacological treatment in the prevention of vasovagal syncope?Arch Mal Coeur Vaiss,1996,89Spec No 1:25-28.
• [9]Wray DW,Formes KJ,Weiss MS,et al.Vagal cardiac function and arterial blood pressure stability.Am J Physiol Heart Circ Physiol,2001,281(5):H1870-H1880.
• [10]Devereaux PJ,Yang H,Yusuf S,et al.Effects of extendedrelease metoprolol succinate in patients undergoing non-cardiac surgery(POISE trial):a randomised controlled trial.Lancet,2008,371(9627):1839-1847.
• [11]van Dijk JG,Sheldon R.Is there any point to vasovagal syncope?Clin Auton Res,2008,18(4):167-169.
• [12]Santini M,Ammirati F,Colivicchi F,et al.The effect of atropine in vasovagal syncope induced by head-up tilt testing.Eur Heart J,1999,20(23):1745-1751.
• [13]Gilani MM,Yarandi F,Eftekhar Z,et al.Comparison of pulse methotrexate and pulse dactinomycin in the treatment of low-risk gestational trophoblastic neoplasia.Aust N Z J Obstet Gynaecol,2005,45(2):161-164.
• [14]TafféP,Sicard N,Pittet V,et al.The occurrence of intraoperative hypotension varies between hospitals:observational analysis of more than 147,000 anaesthesia.Acta Anaesthesiol Scand,2009,53(8):995-1005.
• [15]Bijker JB,Gelb AW.Review article:the role of hypotension in perioperative stroke.Can J Anaesth,2013,60(2):159-167.
• [16]Hallqvist L,Mrtensson J,Granath F,et al.Intraoperative hypotension is associated with myocardial damage in noncardiac surgery:An observational study.Eur J Anaesthesiol,2016,33(6):450-456.
• [17]Meuwly C,Chowdhury T,Gelpi R,et al.The Trigemino-cardiac Reflex:Is Treatment With Atropine Still Justified?J Neurosurg Anesthesiol,2017,29(3):372-373.