Aksu Tolga, Guler Tumer Erdem, Mutluer Ferit Onur, Bozyel Serdar, Golcuk Sukriye Ebru, Yalin Kivanc
Department of Cardiology, Kocaeli Derince Training and Research Hospital, University of Health Sciences, 41500, Kocaeli, Turkey.
Department of Cardiology, Koc University Hospital, Istanbul, Turkey.
J Interv Card Electrophysiol. 2019 Mar;54(2):177-188. doi: 10.1007/s10840-018-0421-4. Epub 2018 Jul 28.
This study was designed to assess the efficacy of electroanatomic-mapping (EAM)-guided cardioneuroablation (CNA) vs combined approach for vasovagal syncope (VVS).
Twenty patients with VVS refractory to conventional treatments who underwent CNA in our institution were enrolled in the study. Twelve of these patients underwent recently introduced EAM-guided CNA using signal-based approach while 8 patients underwent combined CNA using a combination of high-frequency stimulation and spectral analysis. Both atria and coronary sinus were divided into seven segments to categorize distribution of ganglionated plexi in ablation sites. Clinical responses were evaluated and compared in terms of prodromal symptoms and syncope recurrence rates. Electrophysiological parameters and heart rate variability (HRV) analysis were used to evaluate procedural response.
Procedural endpoints were achieved in all cases without any serious adverse events. Compared with the combined approach group, EAM-guided CNA was related to a shorter procedure and fluoroscopy times (p < 0.001). The mean number of ablation points in each anatomical segment was comparable between groups. The prodromal symptoms demonstrated a significant and comparable decrease after CNA. Median event-free survival was comparable between groups (χ2 = 0.03, p = 0.87). There was no new syncopal episode in any case at the end of 6-month follow-up. In the combined approach group, new syncope episodes occurred in two cases after 12-month follow-up. HRV parameters indicating parasympathetic activity were comparably decreased after ablation in both groups.
This pilot study shows that EAM-guided CNA strategy is feasible and safe in VVS patients resistant to conventional therapies.
本研究旨在评估心内神经节标测（EAM）引导下的心神经消融术（CNA）与联合治疗方法对血管迷走性晕厥（VVS）的疗效。
选取20例在我院接受CNA治疗的常规治疗无效的VVS患者纳入研究。其中12例患者最近采用基于信号的方法接受了EAM引导下的CNA，8例患者采用高频刺激和频谱分析相结合的方法接受了联合CNA。将左右心房和冠状窦均分为7个节段，以对消融部位的神经节丛分布进行分类。根据前驱症状和晕厥复发率评估并比较临床反应。采用电生理参数和心率变异性（HRV）分析评估手术反应。
所有病例均达到手术终点，无任何严重不良事件。与联合治疗组相比，EAM引导下的CNA手术时间和透视时间更短（p < 0.001）。两组各解剖节段的平均消融点数相当。CNA术后前驱症状均显著且相当程度地减轻。两组的无事件生存期中位数相当（χ2 = 0.03，p = 0.87）。6个月随访结束时，所有病例均未出现新的晕厥发作。在联合治疗组中，12个月随访后有2例出现新的晕厥发作。两组消融后提示副交感神经活动的HRV参数均相当程度地降低。
这项初步研究表明，EAM引导下的CNA策略对于对常规治疗耐药的VVS患者是可行且安全的。
