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目的探讨心外膜重要结构心外膜脂肪垫在持续性心房颤动(房颤)维持中的作用及机制。方法 22只健康杂种犬,随机分为2组:12只犬通过心外膜快速起搏8周建立持续性房颤模型(A组),10只犬为假手术组(B组)。分别刺激右前脂肪垫、下腔静脉-心房下部脂肪垫、左房背侧脂肪垫,采用心外膜标测技术比较刺激前后标测部位房颤周长变化。消融下腔静脉-心房下部脂肪垫后再次诱发房颤,重复刺激右前脂肪垫并记录刺激前后房颤周长变化。取A组和B组犬脂肪垫标本做组织学检查。结果右侧入路诱发持续性房颤后,刺激右前脂肪垫,发现右上肺静脉、右下肺静脉和右肺静脉前庭房颤周长缩短(P<0.05),右房顶与左房顶房颤周长无明显变化;刺激下腔静脉-心房下部脂肪垫,发现右上肺静脉、右下肺静脉和右肺静脉前庭房颤周长缩短(P<0.05),右房顶与左房顶房颤周长无明显变化。左侧入路诱发持续性房颤后,刺激左房背侧脂肪垫,发现左上肺静脉、左下肺静脉和左肺静脉前庭房颤周长缩短(P<0.05),左房顶与右房顶房颤周长无明显变化。下腔静脉-心房下部脂肪垫消融后,重复诱发房颤,刺激右前脂肪垫时右上肺静脉、右肺静脉前庭房颤周长缩短(P<0.05),右下肺静脉房颤周长无变化。结论持续性房颤犬右前脂肪垫、下腔静脉-心房下部脂肪垫和左房背侧脂肪垫3个脂肪垫通过诱发同侧肺静脉及其前庭快速激动来参与房颤的维持。在持续性房颤时右前脂肪垫主要影响右上肺静脉的房颤周长,并通过下腔静脉-心房下部脂肪垫来影响右下肺静脉;下腔静脉-心房下部脂肪垫对于右下肺静脉的影响要大于右上肺静脉。
Objective To investigate the role and mechanism of epicardial fat pad in the maintenance of persistent atrial fibrillation (AF). Methods Twenty-two healthy canines were randomly divided into 2 groups: 12 dogs were given epicardial rapid paced for 8 weeks to establish continuous AF model group (A group), 10 dogs were sham operated group (B group). The right anterior fat pad, inferior vena cava - inferior atrial fat pad and left atrial fat pad were respectively stimulated. The epicardial mapping technique was used to compare the changes of atrial fibrillation circumference before and after stimulation. Atrial fibrillation was induced again after ablation of the inferior vena cava - the atrial fat pad, and the right anterior fat pad was stimulated repeatedly and the changes of atrial fibrillation circumference before and after stimulation were recorded. Take group A and group B dogs fat pad specimens for histological examination. Results Right anterior approach induced persistent atrial fibrillation and stimulation of the right anterior fat pad, found that right atrium pulmonary vein, right lower pulmonary vein and right pulmonary vestibular ventricular fibrillation circumference shortened (P <0.05), right atrium and left atrial fibrillation perimeter (P <0.05). There was no significant change in the perimeter of right atrium and left atrial appendage atrial fibrillation (P> 0.05). There was no significant change in the depth of vestibular atrial fibrillation of right superior pulmonary vein, right inferior pulmonary vein and right pulmonary vein . Left atrial fibrillation induced atrial fibrillation, left atrial dorsal fat pad and found that the left upper pulmonary vein, left lower pulmonary vein and left ventricle vestibular ventricular circumference shortened (P <0.05), left atrial and right atrial fibrillation week No significant change in length. After ablation of the inferior vena cava - inferior atrial fat pad, the atrial fibrillation was repeated and the perimeter of vestibular atrial fibrillation in the right upper pulmonary vein and right pulmonary vein was shortened (P <0.05) while the right anterior fat pad was stimulated. There was no change in the circumference of the right lower pulmonary vein. Conclusions Three fat pads in the right anterior fat pad, inferior vena cava - inferior atrial fat pad and left atrial dorsal fat pad in persistent atrial fibrillation are involved in the maintenance of atrial fibrillation by inducing ipsilateral pulmonary veins and rapid vestibular stimulation. The right anterior fat pad mainly affects the peri-pulmonary fibrillation circumference of the right upper pulmonary vein during persistent AF and affects the right lower pulmonary vein through the inferior vena cava - the fat pad beneath the atrium. The inferior vena cava - the lower atrial fat pad affects the right lower pulmonary vein Greater than the right upper pulmonary vein.