Influence of cryoablation ablation sequence in atrial fibrillation on vagal reflex and heart rate variability: a retrospective cohort study
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摘要: 目的 评估冷冻消融过程中肺静脉消融顺序对迷走神经反射及心率变异性(HRV)的影响。方法 回顾性分析2020年1月1日-2023年6月30日在我院进行阵发性心房颤动(房颤)冷冻球囊消融术的患者114例。根据冷冻消融顺序, 将患者分为先消融右上肺静脉组(RSPV组, 57例)及先消融左上肺静脉组(LSPV组, 57例)。比较两组迷走神经反射事件及HRV指标。结果 在冷冻消融过程中, 与LSPV组相比, RSPV组迷走神经反射发生率明显降低(28.1% vs 1.8%, P < 0.000 1)。其中, RSPV组发生迷走神经反射1例, 表现为窦性心动过缓; LSPV组发生16例, 表现为窦性心动过缓、房室传导阻滞、心脏停搏(均需要起搏)及低血压。LSPV组与RSPV组消融术后SDNN、SDANN、rMSSD及LF/HF均较术前明显下降(均P < 0.05), 但两组间各项指标相比较均差异无统计学意义。结论 房颤冷冻消融先右肺静脉后左肺静脉的消融顺序能明显减少迷走神经反射的发生。消融后HRV明显下降, 但HRV的变化与消融顺序无关。Abstract: Objective To evaluate the impact of the sequence of pulmonary vein ablation during cryoablation on vagal reflex and heart rate variability (HRV).Methods A retrospective analysis was conducted on 114 paroxysmal atrial fibrillation patients who underwent cryoballoon ablation at our institution from January 1, 2020 to June 30, 2023.Patients were divided into two groups based on the sequence of cryoablation: the firstly right superior pulmonary vein ablation group (RSPV, n=57) and the firstly left superior pulmonary vein ablation group (LSPV group, n=57).Vagal reflex events and heart rate variability indicators between the two groups were compared.Results During cryoablation, the RSPV group had a significantly lower incidence of vagal reflex compared to the LSPV group (28.1% vs 1.8%, P < 0.000 1).Only one case of vagal reflex, manifested as sinus bradycardia, occurred in the RSPV group, while 16 occurred in the LSPV group manifested as sinus bradycardia, atrioventricular block, cardiac arrest (all patients required pacing), and hypotension.Heart rate variability indicators SDNN, SDANN, rMSSD, and LF/HF decreased significantly after ablation compared to those before ablation in the LSPV and RSPV groups (all P < 0.05), but there was no statistically significant difference in the above indicators between the two groups.Conclusion Starting cryoablation from the right pulmonary vein, followed by the left pulmonary vein, significantly reduces the occurrence of vagal reflex during atrial fibrillation cryoablation.While HRV decreases significantly after ablation, the change in HRV is not related to the sequence of ablation.
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Key words:
- cryoablation /
- vagal reflex /
- heart rate variability /
- atrial fibrillation
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图 2 1例表现为房室传导阻滞的典型迷走神经反射
Figure 2. A typical vagal reflex manifested as atrioventricular block
图 3 房颤冷冻消融中心脏自主神经的相互作用
Figure 3. The interaction of cardiac autonomic nervous system during cryoablation of atrial fibrillati
表 1 LSPV组与RSPV组基线资料
Table 1. Baseline data
例(%), X±S 项目 LSPV组
(57例)RSPV组
(57例)P值 年龄/岁 62.42±9.53 65.84±8.87 0.050 女性 22(38.6) 34(59.6) 0.025 高血压 29(50.9) 27(47.4) 0.708 冠心病 12(21.1) 5(8.8) 0.066 糖尿病 4(7.0) 11(19.3) 0.096 BMI/(kg/m2) 23.43±3.52 23.65±3.35 0.738 LA/mm 35.02±5.17 35.81±5.34 0.424 LVEF/% 59.93±6.39 60.00±4.40 0.946 NT-proBNP/(pg/mL) 664.72±643.20 577.65± 625.60 0.465 肌酐/(μmol/L) 102.37±169.94 69.37± 20.55 0.151 肺静脉冷冻次数 8.12±1.57 8.07±2.30 0.887 肺静脉冷冻时间/s 990.53±169.37 997.89± 245.73 0.853 
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表 2 消融术前后HRV指标比较
Table 2. HRV indicators before and after ablation
X±S 项目 术前 术后 LSPV组(57例) RSPV组(57例) LSPV组(57例) RSPV组(57例) SDNN 149.70±47.84 156.54±51.94 77.61±31.321) 68.40±23.511) SDANN 103.07±33.36 108.75±42.20 65.81±25.271) 60.09±24.691) rMSSD 75.21±43.43 78.81±48.97 34.95±23.871) 39.16±25.251) LF/HF 1.25±0.78 1.27±0.59 0.89±1.041) 0.85±0.651) 心率 74.79±16.58 79.00±15.72 76.19±1.72 77.02±12.56 与同组术前比较，1)P < 0.05。
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