Barrio-Lopez María Teresa, Álvarez-Ortega Carlos, Minguito-Carazo Carlos, Franco Eduardo, García-Granja Pablo Elpidio, Alcalde-Rodríguez Óscar, Salvador-Montañés Óscar, Francisco-Pascual Jaume, Macías-Ruíz Rosa, Marco Del Castillo Álvaro, Giacoman-Hernández Sebastián, Expósito-García Víctor, Garcia-Izquierdo Eusebio, Manuel Durán Juan, Calvo-Galiano Naiara, Luis Ibáñez-Criado José, García-Cuenca Enrique, Calero Sofia, Fernandez-Portales Javier, Linhart Markus, Rodriguez-Mañero Moises, Martínez-Alday Jesús Daniel, Sanchez-Quintana Damian, Almendral-Garrote Jesús, Moya-Mitjáns Ángel
Electrophysiology Laboratory and Arrhythmia Unit, HM CIEC MADRID (Centro Integral de Enfermedades Cardiovasculares), Hospital Universitario HM Montepríncipe, HM Hospitales, Madrid, Spain; Instituto de Investigación Sanitaria HM Hospitales, Madrid, Spain.
Cardiology Department, University Hospital La Paz, Madrid, Spain.
JACC Clin Electrophysiol. 2024 Dec;10(12):2711-2724. doi: 10.1016/j.jacep.2024.07.027. Epub 2024 Oct 23.
Cardioneuroablation (CNA) is a promising treatment for syncope.
This study sought to analyze the success and risk of CNA, and to describe predictive factors of CNA success in patients with syncope.
Seventy-seven consecutive patients with syncope treated with CNA in 22 hospitals and at least 6 months of follow-up were included. Patients with reflex cardioinhibitory, mixed syncope, functional sinus node dysfunction (SND), or functional atrioventricular block were included. The primary endpoint was the recurrence of syncope after the CNA.
Mean age was 49.3 ± 13.4 years and 54.5% were women. Five (6.5%) patients presented complications. Three patients presented SND, 1 required a pacemaker. During a median follow-up of 12 months (Q1-Q3: 8-20 months), 26 (33.8%) patients had recurrence of syncope. Women had a significantly higher risk of recurrence compared with men (HR: 3.3; 95% CI: 1.2-8.8; P = 0.016). Patients >50 years of age had a significantly lower risk of recurrence compared with younger patients (HR: 0.3; 95% CI: 0.1-0.9; P = 0.032). The risk of recurrence in mixed syncope was significantly higher than in cardioinhibitory syncope (HR: 4.4; 95% CI: 1.1-17.5; P = 0.033). Syncope recurrence was significantly less frequent in patients treated with general anesthesia or deep sedation compared with conscious sedation (HR: 0.2; 95% CI: 0.1-0.6; P = 0.002). Finally, the number of radiofrequency applications (≤30 or >30) had a significant association with CNA success (HR: 0.4; 95% CI: 0.2-0.9; P = 0.042). These results were adjusted for confounding factors.
In this multicenter study, the effectiveness of CNA was less than previously reported. We found a 3.9% risk of SND. Male sex, age >50 years, cardioinhibitory syncope, general anesthesia or deep sedation, and >30 radiofrequency applications could predict success of CNA for syncope.
心脏神经消融术（CNA）是一种有前景的晕厥治疗方法。
本研究旨在分析CNA的成功率和风险，并描述晕厥患者CNA成功的预测因素。
纳入了22家医院连续接受CNA治疗且随访至少6个月的77例晕厥患者。纳入反射性心脏抑制型、混合型晕厥、功能性窦房结功能障碍（SND）或功能性房室传导阻滞患者。主要终点是CNA术后晕厥复发情况。
平均年龄为49.3±13.4岁，女性占54.5%。5例（6.5%）患者出现并发症。3例患者出现SND，1例需要起搏器。在中位随访12个月（四分位间距：8 - 20个月）期间，26例（33.8%）患者晕厥复发。女性复发风险显著高于男性（风险比：3.3；95%置信区间：1.2 - 8.8；P = 0.016）。年龄>50岁的患者复发风险显著低于年轻患者（风险比：0.3；95%置信区间：0.1 - 0.9；P = 0.032）。混合型晕厥的复发风险显著高于心脏抑制型晕厥（风险比：4.4；95%置信区间：1.1 - 17.5；P = 0.033）。与清醒镇静相比，全身麻醉或深度镇静治疗的患者晕厥复发频率显著更低（风险比：0.2；95%置信区间：0.1 - 0.6；P = 0.002）。最后，射频应用次数（≤30次或>30次）与CNA成功有显著关联（风险比：0.4；95%置信区间：0.2 - 0.9；P = 0.042）。这些结果对混杂因素进行了校正。
在这项多中心研究中，CNA的有效性低于先前报道。我们发现SND风险为3.9%。男性、年龄>50岁、心脏抑制型晕厥、全身麻醉或深度镇静以及射频应用次数>30次可预测CNA治疗晕厥的成功。
