Arrhythmia Unit-Heart Institute (Incor), University of São Paulo Medical School, São Paulo, Brazil.
Arrhythmia Unit-Heart Institute (Incor), University of São Paulo Medical School, São Paulo, Brazil.
JACC Clin Electrophysiol. 2023 Aug;9(8 Pt 1):1344-1353. doi: 10.1016/j.jacep.2023.01.032. Epub 2023 Mar 22.
Functional bradycardia is a challenging condition that affects a healthy population. Ganglionated plexus ablation has emerged as a therapeutic alternative to avoid a pacemaker.
The purpose of this study is to evaluate long-term effects of anatomically guided cardiac denervation.
This is a prospective longitudinal study that included 36 patients with symptomatic functional bradycardia. Electroanatomic reconstruction of both atria was carried out, and the main septal ganglionated plexi were anatomically located and targeted.
Ablation endpoints were: 1) heart rate increment; 2) Wenckebach cycle length shortening; and 3) atrio-Hisian (AH) interval shortening. A sinus node denervation was obtained in all patients with an increment of 21.6% in the mean heart rate. All patients presented a negative atropine test after ablation. Twenty-eight (77.7%) patients presented immediate sings of atrioventricular node denervation, with a shortening of 15.6% of mean Wenckebach cycle length and 15.9% of the mean AH interval. All heart rate variability parameters showed a significant reduction after 12 months, enduring after 18 months. Thirty (83.3%) patients remained free of events after a mean follow-up of 52.1 ± 35.2 months. One patient (2.77%) presented acute sinus node artery occlusion during ablation with persistent sinus dysfunction and had a pacemaker implantation; 3 (8.3%) other patients evolved with sinus tachycardia, and 4 (11.1%) patients presented syncope recurrence during follow-up, 3 (8.3%) of them requiring a pacemaker implantation. No other tachyarrhythmia was observed.
The anatomically guided septal approach is an effective technique for syncope prevention, promoting long-lasting autonomic changes. No significant proarrhythmia effect has been observed during the long-term follow-up.
功能性心动过缓是一种影响健康人群的具有挑战性的病症。神经节丛消融术已成为一种替代起搏器的治疗选择。
本研究旨在评估解剖指导下心内去神经术的长期效果。
这是一项前瞻性纵向研究，共纳入 36 例有症状的功能性心动过缓患者。对两心房进行电解剖重建，并对主间隔神经节丛进行解剖定位和靶向消融。
消融终点为：1）心率增加；2）文氏周期长度缩短；和 3）房室结（AH）间期缩短。所有患者均实现了窦房结去神经，平均心率增加 21.6%。所有患者消融后均行阿托品试验均为阴性。28 例（77.7%）患者即刻出现房室结去神经，平均文氏周期长度缩短 15.6%，平均 AH 间期缩短 15.9%。所有心率变异性参数在 12 个月后均显著降低，并在 18 个月后持续降低。30 例（83.3%）患者在平均 52.1±35.2 个月的随访后无事件发生。1 例（2.77%）患者在消融过程中出现窦性结动脉闭塞，持续性窦性功能障碍，并植入起搏器；3 例（8.3%）患者出现窦性心动过速，4 例（11.1%）患者在随访期间出现晕厥复发，其中 3 例（8.3%）需要植入起搏器。未观察到其他快速性心律失常。
解剖指导下的间隔方法是预防晕厥的有效技术，可长期持续地改变自主神经功能。在长期随访中未观察到明显的致心律失常作用。
