Kocaeli Derince Education, Training and Research Hospital, Department of Cardiology, University of Health Sciences, 41500, Kocaeli, Turkey.
Faculty of Medicine, Department of Cardiology, Istanbul University-Cerrahpasa, Istanbul, Turkey.
J Interv Card Electrophysiol. 2021 Aug;61(2):385-393. doi: 10.1007/s10840-020-00831-w. Epub 2020 Jul 23.
A significant shortening of the corrected QT interval (QTc) in addition to parasympathetic denervation after cardioneuroablation (CNA) was recently demonstrated in patients with vagally mediated bradyarrhythmias and normal QTc range. This study assessed the effects of CNA on ventricular repolarization and heart rate by using QTc measurements in 2 patients with long QT syndrome (LQTS).
The case series included 2 consecutive patients with significant sinus bradycardia and refractory paroxysmal atrial fibrillation (AF). All atrial ganglionated plexus (GP) sites in addition to pulmonary vein isolation were successively targeted by using electrogram-guided strategy. QTc was calculated on 12-lead ECG before the procedure (time point 1), at post-ablation 24 h (time point 2), and at the last follow-up visit (time point 3), respectively.
In the first case, QTc (Bazett) shortened from 612 to 551 msec between time points 1 and 2 and was 419 msec in time point 3. Similarly, QTc (Bazett) shortened from 480 to 401 msec between time points 1 and 3 in the second case. In both cases, minimum and mean heart rates were significantly increased after ablation. The parameters of which are used to estimate both sympathetic and parasympathetic changes in heart rate variability were significantly decreased after ablation. There were no arrhythmia-related symptoms during follow-up.
The present case series reports a new ablation strategy systematically targeting autonomic GPs in LQTS patients. CNA shortens QTc (through sympathetic modulation) and increases heart rate. Although promising, these preliminary results need to be confirmed in the larger prospective study.
最近在伴有迷走神经介导性心动过缓且 QTc 正常范围的心脏神经消融（CNA）后，除了副交感神经去神经支配外，还观察到校正 QT 间期（QTc）显著缩短。本研究通过 QTc 测量评估了 CNA 对 2 例长 QT 综合征（LQTS）患者心室复极和心率的影响。
该病例系列包括 2 例窦性心动过缓伴难治性阵发性心房颤动（AF）的连续患者。所有心房神经节丛（GP）部位均采用电描记图引导的策略进行靶向消融，除了肺静脉隔离。分别在术前（时间点 1）、消融后 24 小时（时间点 2）和最后一次随访（时间点 3）计算 12 导联心电图的 QTc。
在第一个病例中，QTc（Bazett）在时间点 1 和 2 之间从 612 缩短至 551ms，在时间点 3 时为 419ms。同样，在第二个病例中，QTc（Bazett）在时间点 1 和 3 之间从 480 缩短至 401ms。在这两种情况下，消融后最小和平均心率均显著增加。用于估计心率变异性中交感和副交感变化的参数在消融后显著降低。随访期间无心律失常相关症状。
本病例系列报告了一种新的消融策略，该策略系统地靶向 LQTS 患者的自主 GP。CNA 缩短 QTc（通过交感神经调节）并增加心率。尽管结果有前景，但这些初步结果需要在更大的前瞻性研究中得到证实。
