Division of Cardiology, Policlinico Casilino, Via Casilina 1049, 00169, Rome, Italy.
Department of Cardiology, University of Rome "La Sapienza", Rome, Italy.
J Interv Card Electrophysiol. 2021 Sep;61(3):499-510. doi: 10.1007/s10840-020-00840-9. Epub 2020 Aug 6.
Several reports have focused on biatrial ganglionated plexi (GP) transcatheter ablation to treat cardioinhibitory neurocardiogenic syncope (CNS). Considering that anatomical studies showed a significant number of GP in the right atrium (RA), we hypothesized that RA "cardioneuroablation" could be an effective treatment for CNS.
Eighteen consecutive patients (mean age: 36.9 ± 11.2 years) with severe CNS were submitted to transcatheter ablation of GPs in the RA alone using an anatomical approach. Head up tilt test evaluation was performed during the follow-up period at 6, 12, and 24 months and in case of significant symptoms, while heart rate variability parameters were evaluated at patients discharge at 1, 3, 6, 12, 24, and 36 months after ablation.
At a mean follow-up of 34.1 ± 6.1 months, 3 (16.6%) patients experienced syncopal episodes and 5 patients (27.7%) only prodromal episodes. Syncopal and prodromal recurrences were significantly decreased both in overall population (P = 0.001) and in symptomatic patients after ablation (P = 0.003). Heart rate variability analysis showed the loss of autonomic balance secondary to a reincrease of sympathetic tone after the acute phase faster than vagal tone more evident at 12 months (LF/HF vs preablation, P < 0.001) and persistent until 24 months. Finally, a good correlation was observed between symptomatic events and the extension of RF lesions in supero-, middle-, and infero-posterior RA areas (r = 0.73, P = 0.03; r = 0.85, P = 0.02; r = 0.87, P = 0.004, respectively).
Cardioneuroablation in the RA can be considered safe and an effective technique to treat CNS episodes.
已有数项研究聚焦于心房结神经丛（GP）双心房导管消融术以治疗心脏抑制性神经心源性晕厥（CNS）。鉴于解剖学研究显示右心房（RA）中存在大量的 GP，我们假设 RA“心脏神经消融”可能是治疗 CNS 的有效方法。
18 例严重 CNS 患者采用解剖学方法单独进行 RA 内 GP 的导管消融术。在随访期间（6、12 和 24 个月，以及出现明显症状时）进行直立倾斜试验评估，同时在消融术后 1、3、6、12、24 和 36 个月评估心率变异性参数。
平均随访 34.1±6.1 个月后，3 例（16.6%）患者出现晕厥发作，5 例（27.7%）患者仅出现前驱症状。总人群中（P=0.001）和消融术后有症状的患者中（P=0.003），晕厥和前驱症状的复发均显著减少。心率变异性分析显示，自主平衡丧失继发于交感神经张力的急性后再增加，而迷走神经张力增加则更明显，在 12 个月时（LF/HF 与消融前相比，P<0.001）更为明显，并持续至 24 个月。最后，症状事件与 RA 上、中、后下区域 RF 损伤的范围之间存在良好的相关性（r=0.73，P=0.03；r=0.85，P=0.02；r=0.87，P=0.004）。
RA 中的心脏神经消融术安全有效，可用于治疗 CNS 发作。
