UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California; China Medical University Hospital, Taichung, Taiwan.
UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, Los Angeles, California.
Heart Rhythm. 2023 Nov;20(11):1534-1545. doi: 10.1016/j.hrthm.2023.08.001. Epub 2023 Aug 9.
Cardioneuroablation (CNA) is an attractive treatment of vasovagal syncope. Its long-term efficacy and safety remain unknown.
The purpose of this study was to develop a chronic porcine model of CNA to examine the susceptibility to ventricular tachyarrhythmia (ventricular tachycardia/ventricular fibrillation [VT/VF]) and cardiac autonomic function after CNA.
A percutaneous CNA model was developed by ablation of left- and right-sided ganglionated plexi (n = 5), confirmed by histology. Reproducible bilateral vagal denervation was confirmed after CNA by extracardiac vagal nerve stimulation (VNS) and histology. Chronic studies included 16 pigs randomized to CNA (n = 8) and sham ablation (n = 8, Control). After 6 weeks, animals underwent hemodynamic studies, assessment of cardiac sympathetic and parasympathetic function using sympathetic chain stimulation and direct VNS, respectively, and proarrhythmic potential after left anterior descending (LAD) coronary artery ligation.
After CNA, extracardiac VNS responses remained abolished for 6 weeks despite ganglia remaining in ablated ganglionated plexi. In the CNA group, direct VNS resulted in paradoxical increases in blood pressure, but not in sham-ablated animals (CNA group vs sham group: 8.36% ± 7.0% vs -4.83% ± 8.7%, respectively; P = .009). Left sympathetic chain stimulation (8 Hz) induced significant corrected QT interval prolongation in the CNA group vs the sham group (11.23% ± 4.0% vs 1.49% ± 4.0%, respectively; P < .001). VT/VF after LAD ligation was more prevalent and occurred earlier in the CNA group than in the control group (61.44 ± 73.7 seconds vs 245.11 ± 104.0 seconds, respectively; P = .002).
Cardiac vagal denervation is maintained long-term after CNA in a porcine model. However, chronic CNA was associated with cardiovascular dysreflexia, diminished cardioprotective effects of cardiac vagal tone, and increased susceptibility to VT/VF in ischemia. These potential long-term negative effects of CNA suggest the need for rigorous clinical studies on CNA.
心脏神经消融术（CNA）是治疗血管迷走性晕厥的一种有吸引力的治疗方法。其长期疗效和安全性尚不清楚。
本研究旨在建立一种慢性猪模型，以研究 CNA 后对室性心动过速/心室颤动（VT/VF）和心脏自主神经功能的易感性。
通过消融左、右侧神经节丛（n=5）建立经皮 CNA 模型，通过组织学确认。CNA 后，通过心外膜迷走神经刺激（VNS）和组织学确认双侧迷走神经去神经支配的可重复性。慢性研究包括 16 头猪随机分为 CNA 组（n=8）和假消融组（n=8，对照组）。6 周后，动物行血流动力学研究，分别采用交感链刺激和直接 VNS 评估心脏交感和副交感神经功能，左前降支（LAD）冠状动脉结扎后评估致心律失常潜能。
CNA 后，尽管神经节仍存在于消融的神经节丛中，但心外 VNS 反应仍持续 6 周被阻断。在 CNA 组，直接 VNS 导致血压出现反常增加，但在假消融动物中则没有（CNA 组与假消融组：分别为 8.36%±7.0%和-4.83%±8.7%；P=0.009）。左交感链刺激（8 Hz）在 CNA 组比假消融组引起更明显的校正 QT 间期延长（分别为 11.23%±4.0%和 1.49%±4.0%；P<0.001）。LAD 结扎后，CNA 组比对照组更常见且更早发生 VT/VF（分别为 61.44±73.7 秒和 245.11±104.0 秒；P=0.002）。
在猪模型中，CNA 后心脏迷走神经去神经支配可长期维持。然而，慢性 CNA 与心血管反射亢进、心脏迷走神经张力的心脏保护作用减弱以及缺血时 VT/VF 的易感性增加有关。这些 CNA 的潜在长期负面影响表明需要对 CNA 进行严格的临床研究。
