简化三神经节丛消融术治疗复发性血管迷走性晕厥和功能性缓慢性心律失常。

Simplified 3-ganglionated plexus ablation for the treatment of recurrent vasovagal syncope and functional bradyarrhythmia.

作者信息

Minguito-Carazo Carlos, Martínez-Alday Jesús Daniel, García Seara Javier, Martínez Sande Jose Luis, López Xesus Alberte Fernández, Arias Federico García-Rodeja, Shangutov Olekshander, Teja Juliana Elices, Chana Beatriz González, Ferrero Teba González, Tilves Bellas Carlos, González Juanatey José Ramón, Rodríguez-Mañero Moisés

机构信息

Arrythmias Unit, University Hospital of Santiago de Compostela, Santiago de Compostela, A Coruña, Spain; University of Santiago de Compostela (USC), Santiago de Compostela, A Coruña, Spain; Translational Cardiology Group, Health Research Institute of Santiago de Compostela (IDIS), University of Santiago de Compostela (USC), Sanitafo de Compostela, A Coruña, Spain; CIBERCV, Institute of Health Carlos III, Madrid, Spain.

Cardiology Department, University Hospital Basurto, Bilbao, Spain.

出版信息

Heart Rhythm. 2025 Apr 30. doi: 10.1016/j.hrthm.2025.04.052.

DOI:10.1016/j.hrthm.2025.04.052

PMID:40315940

Abstract

BACKGROUND

Cardioneuroablation (CNA) is an emerging treatment for recurrent vasovagal syncope (VVS), extrinsically mediated atrioventricular block (AVB), and sinus node dysfunction (SND). However, there is ongoing debate regarding the number of ganglionated plexuses (GPs) to ablate.

OBJECTIVE

To evaluate differences in the degree of autonomic denervation and clinical outcomes between a simplified 3-GP ablation strategy and an extensive ablation approach.

METHODS

This is a prospective, observational study of patients with recurrent VVS, extrinsic AVB, or SND. Patients were categorized into group A (3-GP ablation: right superior, left superior, and left posteromedial GP) and group B (additional GP ablation). Primary outcomes included relative heart rate (HR) increase after the atropine test at baseline and 6 months and syncope or pacemaker-free survival in the follow-up.

RESULTS

Overall, 58 patients were included. There were no significant differences in the relative HR increase after the atropine test following CNA (A: 9.9% [4.1-19.0] vs B: 5.6% [2.8-8.4], P = .069) or at 6 months (A: 24.8% [15.0-37.2] vs B: 19.9% [16.8-25.4], P = .277). Similarly, after 19.1 (9.2-26.8) months there were no significant differences in syncope or pacemaker-free survival between groups (A: 15.2% vs B: 32.0%; log-rank P = .467). No significant differences were observed in most HR variability parameters or autonomic functional tests. Both groups showed a significant improvement in the SF-36 quality-of-life score (physical function p<.001, health change P < .001). Procedural time (P = .036) and fluoroscopy time (P = .015) were significantly shorter in the only 3-GP group.

CONCLUSION

A simplified 3-GP ablation strategy resulted in similar autonomic denervation and clinical outcomes compared with an extended ablation approach.

摘要

背景

心脏神经消融术（CNA）是一种针对复发性血管迷走性晕厥（VVS）、外在介导的房室传导阻滞（AVB）和窦房结功能障碍（SND）的新兴治疗方法。然而，关于需要消融的神经节丛（GPs）数量仍存在争议。

目的

评估简化的三神经节丛消融策略与广泛消融方法在自主神经去神经程度和临床结果方面的差异。

方法

这是一项针对复发性VVS、外在性AVB或SND患者的前瞻性观察研究。患者被分为A组（三神经节丛消融：右上、左上和左后内侧神经节丛）和B组（额外的神经节丛消融）。主要结局包括基线和6个月时阿托品试验后相对心率（HR）增加以及随访期间的晕厥或无起搏器生存率。

结果

总共纳入了58例患者。CNA术后阿托品试验后相对HR增加（A组：9.9% [4.1 - 19.0] 对比B组：5.6% [2.8 - 8.4]，P = 0.069）或6个月时（A组：24.8% [15.0 - 37.2] 对比B组：19.9% [16.8 - 25.4]，P = 0.277）均无显著差异。同样，在19.1（9.2 - 26.8）个月后，两组间晕厥或无起搏器生存率也无显著差异（A组：15.2% 对比B组：32.0%；对数秩检验P = 0.467）。在大多数HR变异性参数或自主神经功能测试中未观察到显著差异。两组的SF - 36生活质量评分均有显著改善（身体功能p < 0.001，健康变化P < 0.001）。仅三神经节丛组的手术时间（P = 0.036）和透视时间（P = 0.015）显著更短。