Li Chenze, Hu Yingying, Li Yi, Zeng Ziyue, Yu Wenxi, Zhou Zhen, Qiu Hao, He Bo, Lu Zhibing
Department of Cardiology, Zhongnan Hospital of Wuhan University, Wuhan, 430071, Hubei, China.
Hubei Provincial Clinical Research Center for Interventional Diagnosis and Treatment of Cardiovascular Diseases, Institute of Myocardial Injury and Repair, Wuhan University, Wuhan, 430071, Hubei, China.
BMC Cardiovasc Disord. 2025 Jul 14;25(1):505. doi: 10.1186/s12872-025-04933-z.
Cardioneuroablation is increasingly being adopted as a treatment for vasovagal syncope (VVS). Identification of the cardiac ganglionated plexus (GP) is a critical factor influencing the outcome of the procedure. This study sought to compare the efficacy of tentative anatomical ablation (TAA) and high-frequency electrical stimulation (HFS) in locating the GP.
A total of 58 patients diagnosed with VVS were consecutively enrolled, including 46 patients with the cardioinhibitory type and 12 patients with the mixed type who exhibited a significant decrease in heart rate (HR). The first 19 enrolled patients simultaneously underwent HFS- and TAA-guided GP localization. All patients underwent anatomical GP ablation.
The number of GP sites with a positive response to TAA was significantly greater than those from HFS (15 ± 4 per person vs. 12 ± 4 per person; p < 0.001). Following anatomical ablation, the patients exhibited an increase in HR (69 ± 13 bpm vs. 91 ± 13 bpm, p < 0.001), a reduction in sinus node recovery time (1155 ± 169 ms vs. 934 ± 162 ms, p < 0.001), an enhancement of atrioventricular conduction (Wenckebach point: 418 ± 87 ms vs. 338 ± 41 ms; effective refractory period of atrioventricular node: 334 ± 84 ms vs. 254 ± 54 ms, all p < 0.001), and a reduction in heart rate variability (HRV) (HRV: 146 ± 64 ms vs. 67 ± 29 ms; high frequency: 309.18 ± 99.42 vs. 24.21 ± 12.73, all p < 0.001). During a median follow-up of 18 months, the rate of freedom from syncope recurrent was 94.8%, with no statistically significant differences observed in age, gender, or type of head-up tilt test.
In GP localization, TAA-guided responses demonstrated greater precision and wider distribution compared to HFS-guided approaches. Anatomical GP ablation can significantly decrease autonomic tone and prevent syncope in patients with VVS.
Not applicable.
心脏神经消融术越来越多地被用作血管迷走性晕厥（VVS）的一种治疗方法。识别心脏神经节丛（GP）是影响该手术结果的关键因素。本研究旨在比较试探性解剖消融（TAA）和高频电刺激（HFS）在定位GP方面的疗效。
连续纳入58例诊断为VVS的患者，其中46例为心脏抑制型，12例为混合型，均表现出心率（HR）显著下降。前19例纳入患者同时接受了HFS和TAA引导的GP定位。所有患者均接受了解剖学GP消融。
TAA引导下出现阳性反应的GP部位数量显著多于HFS引导下的数量（每人15±4个 vs. 每人12±4个；p<0.001）。解剖消融后，患者的HR增加（69±13次/分 vs. 91±13次/分，p<0.001），窦房结恢复时间缩短（1155±169毫秒 vs. 934±162毫秒，p<0.001），房室传导增强（文氏点：418±87毫秒 vs. 338±41毫秒；房室结有效不应期：334±84毫秒 vs. 254±54毫秒，均p<0.001），心率变异性（HRV）降低（HRV：146±64毫秒 vs. 67±29毫秒；高频：309.18±99.42 vs. 24.21±12.73，均p<0.001）。在中位随访18个月期间，晕厥复发率为94.8%，在年龄、性别或直立倾斜试验类型方面未观察到统计学显著差异。
在GP定位中，与HFS引导方法相比，TAA引导的反应显示出更高的精度和更广泛的分布。解剖学GP消融可显著降低自主神经张力并预防VVS患者的晕厥。
不适用。
