Selective Ablation of the Ligament of Marshall Reduces the Prevalence of Ventricular Arrhythmias Through Autonomic Modulation in a Cesium-Induced Long QT Canine Model

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• 作者：Songyun Wang ; MD ; Zhibing Lu ; MD ; PhD ; Wenbo He ; MD ; PhD ; Bo He ; MD ; PhD ; Jing Xie ; PhD ; Xiaomei Yu ; PhD ; Hong Jiang ; MD ; PhD ; ^{hong-jiang@whu.edu.cn" class="auth_mail" title="E-mail the corresponding author}
• 关键词：autonomic nervous system ; left stellate ganglion ; ligament of Marshall ; ventricular arrhythmias
• 刊名：JACC: Clinical Electrophysiology
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：2
• 期：1
• 页码：97-106
• 全文大小：2217 K

文摘

The goal of this study was to investigate the effect of selective ablation of the ligament of Marshall (LOM) on ventricular arrhythmias (VAs).

Background

Previous studies have shown that selective stimulation of sympathetic elements of the LOM, the distal segment of the ligament of Marshall that extends beyond the left superior pulmonary vein (LOM_LSPV), might induce VAs.

Methods

In protocol 1, the blood pressure and ventricular effective refractory period changes as a response to LOM_LSPV stimulation and left stellate ganglion (LSG) stimulation were measured before and after LOM_LSPV ablation in 8 anesthetized dogs. In protocol 2, a total of 24 dogs were randomly divided into group 1 (cesium alone, n = 8), group 2 (cesium combined with LSG stimulation, n = 8), and group 3 (cesium combined with LSG stimulation after LOM_LSPV ablation, n = 8). Early afterdepolarization amplitude, VA prevalence, and the tachycardia threshold (measured according to the dose of cesium administered) were compared among the groups.

Results

In protocol 1, both LOM_LSPV stimulation and LSG stimulation significantly increased blood pressure and shortened the ventricular effective refractory period, both of which were significantly attenuated by LOM_LSPV ablation. In protocol 2, compared with group 1, the prevalence of VAs and the early afterdepolarization amplitudes were significantly augmented in group 2 and were maintained at a comparable level in group 3. Furthermore, the tachycardia threshold in group 2 (0.625 mmol/kg) was significantly lower than that noted in groups 1 and 3 (both 1.000 mmol/kg; p < 0.05).

Conclusions

LOM_LSPV ablation reduced the prevalence of the VAs induced by cesium in combination with LSG stimulation, and the antiarrhythmic effect may involve the blockade of the sympathetic conduit between the LSG and the ventricles.