Clinical Study Of Cardiac Autonomic Ganglion Plexus Ablation In The Treatment Of Bradyarrhythmia

Objective: The main cause of bradyarrhythmia is the imbalance of vagulent nerve and sympathetic tension,which is often accompanied by very obvious symptoms.Those symptoms generally require cardiac pacemaker implanted for relief.Heart ganglion plexus ablation,a new technique based on a vagus gangfu-frequency ablation,can be used in the treatment of bradyarrhythmia,but there are few reports at home and abroad.This study aims to investigate the clinical treatment of left atrial heart membrane ganglionated plexi ablation on bradyarrhythmia.Methods:(1)Selecting cardiology tainard patients(study group,n=268 cases)at the Xinjiang Medical University First Affiliated Hospital and Xuancheng People's Hospital from January 2018 to December 2018 and of healthy individuals in physical examinations at the same period(control group,n=266 cases)as research objects.24 h dynamic electrocardiogram(Holter),heart rate acceleration(AC),heart rate reduction force(DC)and heart rate variability(HRV)were applied to the research objects to evaluate the cardiac autonomic nervous function of patients with Bradyarrhythmia.The HRV index includes SDNN,SDNN INDEX,RMSSD,PNN50,Triangle Index,HF,LF.(2)Selecting 21 patients suffering atrial fibrillation with bradyarrhythmia and receiving first-time radiofrequency ablation at the First Affiliated Hospital of Xinjiang Medical University and Xuancheng People's Hospital from January2019 to December 2019 as a study group.The age of the group was 59.76 ± 8.03 years.Among them,10 patients were female,11 males.20 patients suffering atrial fibrillation without bradyarrhythmia and receiving first-time radiofrequency ablation at the same hospitals during the same period were selected as a control group.The age of the group was 59.5±8.12 years with 10 males and 10 females.Comparative analysis was made on the heart rate variability before and after ablation in the control group.(3)Continuously incorporating 50 cases of patients with bradyarrhythmia treated by the First Affiliated Hospital of Xinjiang Medical University from September 2019 to August 2020(25 men,averaged 33.16±7.89 years old).For them,the routinary treatment was invalid;or they couldn't withstand the side effect.(1)Detecting HRV indexes before and after ablation respectively,using 24-hour Holter recorder for Holter inspection,using built-in software to analyze HRV information,recording average heart rate and HRV indexes,among which frequency domain analysis indexes and time domain indexes were used as HRV analysis indicators;LF,HF and LF/HF were used as frequency domain analysis indicators,and SDANN,rMSSD,SDNN and PNN50 were used as time domain analysis indicators.The serum tyrosine hydroxylase concentration and sympathetic nerve skin reaction were measured before and after ablation respectively.(2)Under the guidance of the Carto3 mapping system,the left atrium was modeled with Pentary,and the autonomic ganglion plexus of the left atrium endocardium was ablated under the guidance of anatomical positioning and high-frequency stimulation,and the disappearance of the vagus response was confirmed as the ablation end point.Patients were followed up regularly after ablation,and Holter's data were recorded at 3,6 and 12 months after ablation.Result:(1)Compared with the control group,HRV correlation indicators of the study group like DC value and SDNN,SDNN INDEX,RMSSD,PNN50,an Triangle index and HF significantly increased(P<0.05),AC,LF and LF/HF significantly decreased.In the two groups,the HRV values(DC value and SDNN,SDNN INDEX,RMSSD,PNN,SDNN Index,RMSSD,PNN50,and Triangle Index,HF)of those above 50 years old were lower than those below 50 years old,and the AC value,LF and LF/HF of those above 50 was higher than those under 50(P<0.05);Whether in a control group or a research group,there was no significant difference between men and women;the DC value of the control group and the study group was significantly positively correlated with SDNN,SDNN Index,RMSSD,PNN50,Triangle Index,HF and LF.AC value was remarkably negatively related to SDNN,SDNN INDEX,RMSSD,PNN50,Triangle Index,HF and LF.(2)The endpoint of the ablation was reached within the ablation procedure.Prior to the surgery,Mean HR and LF/HF of the study group were significantly lower and SDNN,SDNNindex and HF were significantly higher than those of the control group;there were significant differences(P <0.05),while the other HRV time domain and frequency domain showed no significant difference(P>0.05);after the ablation the average HR in all patients significantly increased;there was a significant difference(P<0.01).After ablation SDNN,SDANN and p NN50 parameters decreased,and LF,LF/HF increased significantly,registering a significant difference(P<0.01);no significant difference(ablation average HR between two groups 3 months,P>0.05)could be found,SDNN decreased,LF/HF increased significantly,and there was a significant difference(P<0.05);compared with that prior to the surgery,the average HR in the study group rose;SDANN and SDNN significantly lowered,LF and LF/HF significantly increased.In the control group the average HR rose;SDANN,SDNN,PNN50 and other index was significantly lowered and there was a significant(P<0.01)difference,but Mean HR,rMSSD,LF,HF and LF/HF were not statistically significant;One year after the ablation,both study group and the control group saw a reduction in LAD,and there was significant difference(P<0.05).The LAD reduction in the study group was comparatively more significant.(3)All patients have successfully induced a vagulent response in ablation,and reduced the results to the vague response;there was no complications in the operation,and there was no recurrence case in December.After ablation,Meanhr increased,DC value and HRV indicators were lower than those before the ablation,and the AC value was higher than that before ablation(P <0.05).After the ablation,the Th concentration rose and the amplitude of SSR were significantly higher than that of catheter ablation,and there was no significant difference in the SSR latency after ablation(P>0.05).Conclusion: The DC value of patients with bradyarrhythmias was significantly positively correlated with SDNN,SDNNindex,MSSD,PNN50,triangle index,HF and LF,and the AC value was significantly negative with SDNN,SDNNindex,MSSD,PNN50,triangle index,HF and LF.The above indexes can be used to evaluate the autonomic nerve function of bradyarrhythmia.The increase in DC and decrease in AC value indicate that the vagus nerve tension is abnormally high and the function of the cardiac autonomic nerve is unbalanced.When atrial fibrillation accompanied by bradyarrhythmia undergoes ablation,the GP of the pulmonary vein orifice is involved during ablation,and the function of the vagus nerve is affected.The parameters of SDNN,SDANN,PNN50 and HF are significantly reduced after ablation,and the LF/HF is significantly increased.Autonomic dysfunction was partially restored,leading to an increase in the average postoperative ventricular rate.After GP ablation of the left atrium in patients with bradyarrhythmia,DC was significantly reduced,AC,TH and the limb amplitude in SSR was significantly increased,suggesting that GP ablation caused damage to cardiac vagus nerve function and sympathetic tone relative enhancement can effectively increase heart rate and treat bradyarrhythmias.However,its long-term benefit requires further confirmation by largescale randomized controlled clinical research.