摘要
目的近期研究认为富含浦肯野纤维的左心室后乳头肌存在明显的心电不均一性，可能是心室颤动（室颤）发生与维持的重要区域。本实验探索以经皮导管乙醇消融左心室后乳头肌，破坏致心律失常基质，从而预防和治疗室颤的可行性。方法13只猪麻醉后，行双侧股动、静脉穿刺，置入鞘管及标测导管。后乳头肌消融术前，所有动物均以程序期前刺激诱发室颤。在经超声心动图和x线引导下，将微导管连同0．014S导丝通过导引导管刺入左心室后乳头肌，撤出导丝，通过微导管中心腔注射无水乙醇（消融组6只）或生理盐水（对照组6只）1～1．5ml，实施后乳头肌化学消融。结果后乳头肌微导管刺入后，1只猪死于心脏压塞，12只猪完成经皮导管注射术。消融组1只诱发出持续室颤（1／6），对照组6只均诱发出室颤（6／6），左心室后乳头肌经皮导管乙醇消融术后持续性室颤的诱发率明显减低（P〈O．01）。结论对正常猪在体心脏左心室后乳头肌基底部乙醇消融可以降低程序期前刺激诱发的室颤的几率。左心室后乳头肌可能是室颤发生与维持的重要致心律失常基质。
Objectives The exact mechanism of ventricular fibrillation （VF） is still uncertain. According to current research,left ventricular posterior papillary muscle （PPM） is rich in purkinje fiber with significant transmembrane dispersion of repolarization. Hence, they could be the critical site of initiation and maintenance of VF. This research tries to electrically isolate PPM by percutaneous catheter alcohol ablation, to prevent and treat VF by destroying the arrhythmic substrate of VF. Methods Thirteen anesthetized swine underwent both femoral artery and femoral vein puncture, as well as sheath insertion. Before PPM ablation, VF was induced by programmed extra RV stimulation in each animal. Under the guidance of transthoracic echocardiography and fluoroscopy,a micro-catheter with a stiff 0. 014 inch guide wire （supported by a transaortic guiding catheter） were punctured into the PPM. After the guide wire was withdrawn, chemical ablation was perfbrmed by injecting dehydrated alcohol （ ablation group, n = 6 ） or saline （ control group, n = 6 ） into the base of PPM through the central lumen of the micro-catheter. Results After PPM puncture, One animal was dead due to cardiac tamponade,twelve animals were performed percutaneous transcatheter injection. In ablation group,no VF were induced by programmed RV stimulation in three animals （3/6） and two of them had no VF induced by further RV extra pacing either; two animals （2/6） had induced nonsustained VF and self terminated in several sec- onds; one animal （1/6） had induced sustained VF. In control group,all six animals （6/6） had induced sustained VF. The inducibility of sustained VF was significantly reduced by percutaneous catheter alcohol ablation on posterior papillary muscle （ P〈0.01 ）. Conclusion Percutaneous catheter alcohol ablation of the left ven- tricular PPM could reduce VF inducibility in normal intact swine hearts. This suggests that the PPM may be in- volved in the generation and maintenance of VF.
出处
《中华心律失常学杂志》
2011年第6期439-441,共3页
Chinese Journal of Cardiac Arrhythmias
基金
国家自然科学基金（30770875）
关键词
化学消融
心室颤动
后乳头肌
猪
Chemical ablation
Ventricular fibrillation
Posterior papillary muscle
Swine
