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目的探讨消融犬Marshall韧带对刺激心房左后脂肪垫所致心房颤动(简称房颤)的影响及机制。方法成年杂种犬14条,随机分为实验组8条,对照组6条。实验组首先测量左肺静脉和左心耳的有效不应期,继而刺激心房左后脂肪垫诱发房颤。消融Marshall韧带上段后和下段后重复上述步骤。对照组除不干预Marshall韧带外,其它电刺激方案与实验组相同,同时对该组犬的心脏进行迷走神经染色。结果①实验组消融Marshall韧带后,左肺静脉和左心耳的有效不应期均显著延长(P<0.05)。②和消融前比较,实验组消融Marshall韧带上段后的房颤诱发率有下降趋势(70.8%vs87.5%,P>0.05);消融Marshall韧带全程后房颤诱发率显著下降(33.3%,P<0.001)。对照组三次电刺激所测得的不应期和房颤诱发率无差异。③Marshall韧带与左下肺静脉、心房左后脂肪垫、左心耳之间存在迷走神经的直接联系。结论消融犬Marshall韧带可显著降低刺激心房左后脂肪垫所致房颤的诱发率。
Objective To investigate the effect and mechanism of ablation of Marshall ligament in dogs on atrial fibrillation induced by left atrial fat pad in atrial fibrillation (AF). Methods Fourteen adult hybrid dogs were randomly divided into experimental group 8, control group 6. The experimental group first measured the effective refractory period of the left pulmonary vein and left atrial appendage, which in turn stimulated atrial fibrillation in the left atrial fat pad. After ablating the upper and lower segments of the upper segment of the Marshall ligament, repeat the above procedure. In addition to the control group did not intervene Marshall ligament, the other electrical stimulation program and the experimental group the same time, the group of dogs heart vagus nerve staining. Results ① In the experimental group, the effective refractory period of left pulmonary vein and left atrial appendage were significantly prolonged (P <0.05) after ablation of Marshall ligament. ② Compared with the pre-ablation, the induced rate of atrial fibrillation in the upper part of the lumbar segment of Marshall ablated (70.8% vs 87.5%, P> 0.05) after ablation of the upper segment of Marshall ligament. The rate of atrial fibrillation induced by ablation of the whole ligament of Marshall decreased significantly (33.3%, P <0.001). The control group of three electrical stimulation measured refractory period and induction of atrial fibrillation rate was no difference. ③ Marshall ligament and the left lower pulmonary vein, left atrial fat pad, left atrial appendage between the vagus nerve is the direct link. Conclusion Dissociated dog Marshall ligament can significantly reduce the rate of atrial fibrillation induced by stimulation of atrial appendage.