Herweg Bengt, Patel Ritesh S, Noujaim Sami, Spano Joseph, Mencer Nicholas, Vijayaraman Pugazhendhi
Division of Cardiovascular Sciences, University of South Florida Morsani College of Medicine, Tampa, Florida.
Department of Molecular Pharmacology and Physiology, Morsani College of Medicine, University of South Florida, Tampa, Florida.
Heart Rhythm O2. 2024 Mar 20;5(4):209-216. doi: 10.1016/j.hroo.2024.03.004. eCollection 2024 Apr.
Cardioneuroablation (CNA) targeting ganglionated plexi has shown promise in treating vasovagal syncope. Only radiofrequency ablation has been used to achieve this goal thus far.
The purpose of this study was to investigate the utility of cryoballoon ablation (CBA) of the pulmonary veins (PVs) as a potential simplified approach to CNA.
We report our observations of autonomic modulation in a series of 17 patients undergoing CBA for atrial fibrillation and our early experience using CBA of the PVs in 3 patients with malignant vagal syncope. In 17 patients undergoing CBA of AF, sinus cycle length was recorded intraprocedurally after ablation of individual PVs.
The most pronounced shortening of the sinus cycle length was observed after isolation of the right upper PV, which was ablated last. Reduced sinus node recovery time and atrioventricular (AV) nodal effective refractory period were observed after CBA. Resting heart rate was elevated by 6-7 bpm after CBA and persisted during 12-month follow-up. CBA of the PVs was performed in 3 patients with recurrent vagal syncope mediated by sinus arrest (n = 2) and AV block (n = 1). In all patients, isolation of the right upper PV resulted in marked shortening of sinus cycle length. During follow-up of 178 ± 43 days (134-219 days), CNA resulted in abolition of pauses, bradycardia-related symptoms, and syncope in all patients.
CBA of the PVs (particularly the right upper PV) may be a predictable anatomic CNA approach in patients with refractory vagal syncope due to sinus arrest and/or AV block and may warrant systematic investigation as a tool to perform CNA.
针对神经节丛的心脏神经消融术（CNA）在治疗血管迷走性晕厥方面已显示出前景。迄今为止，仅使用射频消融来实现这一目标。
本研究的目的是探讨肺静脉（PVs）冷冻球囊消融术（CBA）作为一种潜在的简化CNA方法的实用性。
我们报告了对17例因心房颤动接受CBA的患者自主神经调节的观察结果，以及我们对3例恶性迷走性晕厥患者使用PVs的CBA的早期经验。在17例接受房颤CBA的患者中，在消融单个PVs后术中记录窦性周期长度。
在最后消融的右上PV隔离后，观察到窦性周期长度最明显的缩短。CBA后观察到窦房结恢复时间和房室（AV）结有效不应期缩短。CBA后静息心率升高6 - 7次/分钟，并在12个月的随访期间持续存在。对3例由窦性停搏（n = 2）和房室传导阻滞（n = 1）介导的复发性迷走性晕厥患者进行了PVs的CBA。在所有患者中，右上PV的隔离导致窦性周期长度明显缩短。在178±43天（134 - 219天）的随访期间，CNA导致所有患者的停搏、心动过缓相关症状和晕厥消失。
PVs（特别是右上PV）的CBA可能是因窦性停搏和/或房室传导阻滞导致的难治性迷走性晕厥患者一种可预测的解剖学CNA方法，并且作为一种进行CNA的工具可能值得进行系统研究。
