USP, Sao Paulo University, Brazil (Jose Carlos Pachon-M, E.I.P.-M., Juan Carlos Pachon-M, R.C.A., R.F.S.).
HCor, Sao Paulo Heart Hospital (Jose Carlos Pachon-M, E.I.P.-M., C.T.C.P., T.G.S.-P., T.J.L., Juan Carlos Pachon-M, J.C.Z.-A., M.Z.C.P., C.H., F.A.O., R.C.A., R.F.S., T.G.O.).
Circ Arrhythm Electrophysiol. 2020 Dec;13(12):e008703. doi: 10.1161/CIRCEP.120.008703. Epub 2020 Nov 16.
Several disorders present reflex or persistent increase in vagal tone that may cause refractory symptoms even in a normal heart patient. Cardioneuroablation, the vagal denervation by radiofrequency ablation of the neuromyocardial interface, was developed to treat these conditions without pacemaker implantation. A theoretical limitation could be the reinnervation, that naturally grows in the first year, that could recover the vagal hyperactivity. This study aims to verify the vagal denervation degree in the chronic phase after cardioneuroablation. Additionally, it intends to investigate the arrhythmias behavior after cardioneuroablation.
Prospective longitudinal study with intrapatient comparison of 83 very symptomatic cases without significant cardiopathy, submitted to cardioneuroablation, 49 (59%) male, 47.3±17 years old, having vagal paroxysmal atrial fibrillation 58 (70%) or neurocardiogenic syncope 25 (30%), New York Heart Association class<II and absence of significant comorbidities. Cardioneuroablation was performed in both atria by interatrial septum puncture, with irrigated conventional catheter and electroanatomic reconstruction. Ablation targeted the neuromiocardial interface by fragmentation mapping (AF-Nests) using the velocity fractionation software, conventional recording, and anatomic localization of the ganglionated plexi. Heart rate variability (time and frequency domain) and arrhythmias were compared by 24h-Holter, before, and 1 year and 2 years after cardioneuroablation. In a 40 month follow-up, 80% of patients were asymptomatic.
Time- and frequency-domain heart rate variability demonstrated significant decrease in all autonomic parameters, showing an important parasympathetic and sympathetic activity reduction at 2-year post-cardioneuroablation (<0.001). There was no difference in heart rate variability between the 1-year and 2-year post-cardioneuroablation (>0.05) suggesting that the reinnervation has halted. There was also an important reduction in all bradyarrhythmias and tachyarrhythmias pre-cardioneuroablation versus post-cardioneuroablation (<0.01).
There is an important and significant vagal and sympathetic denervation after 2 years of cardioneuroablation with a significant reduction in bradyarrhythmia and tachyarrhythmia in the whole group. There were no complications.
一些疾病表现出反射性或持续性的迷走神经张力增加，即使在正常心脏患者中也可能导致难治性症状。心脏神经消融术是通过射频消融心肌神经界面来实现的，用于治疗这些没有起搏器植入的情况下的疾病。一个理论上的限制可能是神经再支配，即自然在第一年生长，这可能会恢复迷走神经的过度活跃。本研究旨在验证心脏神经消融术后慢性期的迷走神经去神经支配程度。此外，它还旨在研究心脏神经消融术后心律失常的行为。
对 83 例症状非常明显但无明显心脏病的患者进行前瞻性纵向研究，这些患者均接受了心脏神经消融术，其中男性 49 例（59%），年龄 47.3±17 岁，阵发性房性房颤 58 例（70%）或神经心源性晕厥 25 例（30%），纽约心脏协会（NYHA）心功能分级<Ⅱ级，无明显合并症。通过房间隔穿刺，使用灌流常规导管和电解剖重建，在左右心房进行心脏神经消融术。消融的靶点是通过碎裂图（AF-Nests）进行的心肌神经界面，使用速度分数软件、常规记录和神经节丛的解剖定位。在心脏神经消融术前、术后 1 年和 2 年，通过 24 小时动态心电图（Holter）比较心率变异性（时域和频域）和心律失常。在 40 个月的随访中，80%的患者无症状。
时间和频率域心率变异性显示所有自主参数均显著下降，提示心脏神经消融术后 2 年时迷走神经和交感神经活动明显减少（<0.001）。心脏神经消融术后 1 年和 2 年之间的心率变异性无差异（>0.05），提示神经再支配已经停止。心脏神经消融术前与术后相比，所有缓慢性心律失常和快速性心律失常均显著减少（<0.01）。
心脏神经消融术后 2 年，迷走神经和交感神经有明显而重要的去神经支配，整个组的缓慢性心律失常和快速性心律失常均显著减少。无并发症发生。
