The impacts of the ganglionated plexus ablation sequence on the vagal response, heart rate, and blood pressure during cardioneuroablation,Autonomic Neuroscience

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The impacts of the ganglionated plexus ablation sequence on the vagal response, heart rate, and blood pressure during cardioneuroablation
Autonomic Neuroscience ( IF 2.7 ) Pub Date : 2021-04-20 , DOI: 10.1016/j.autneu.2021.102812
Feng Hu ₁ , Lihui Zheng ₂ , Shangyu Liu ₂ , Lishui Shen ₂ , Erpeng Liang ₂ , Limin Liu ₂ , Lingmin Wu ₂ , Ligang Ding ₂ , Yan Yao ₂

Affiliation

Aims

Cardioneuroablation is an emerging and promising therapy to treat vasovagal syncope (VVS). The aim of this study was to assess the characteristics of vagal response (VR), heart rate (HR), and blood pressure (BP) during cardioneuroablation with different sequences of ganglionated plexus (GPs) catheter ablation and clarify the regulatory mechanism of cardiac GPs of the left atrium.

Methods

A total of 28 patients with VVS who underwent cardioneuroablation were prospectively enrolled and randomly assigned to 2 groups according to the ablation order of GPs. Group A: Left superior GP (LSGP) - Left inferior GP (LIGP) - Right inferior GP (RIGP) - Right anterior GP (RAGP); Group B: RAGP - LSGP - LIGP - RIGP.

Results

In Group A, the VR in LSGP, LIGP, RIGP, and RAGP during ablation was observed in 11 (78.6%), 5 (35.7%), 4 (28.6%) and 2 (14.3%) cases, respectively. In contrast, in Group B, the VR in RAGP, LSGP, LIGP, and RIGP was observed in 2 (14.3%), 1 (7.1%), 0 (0%) and 0 (0%) cases, respectively. BP reduction during procedure was observed eight times in Group A and once in Group B (P = 0.013). In both groups, the HR increased significantly during ablation of the RAGP (all P < 0.001).

Conclusion

The sequence of GPs ablation during cardioneuroablation affected the occurrence rate of VR and BP reduction during cardioneuroablation. The RAGP was a critical target to increase HR and inhibit VR and BP reduction during procedure, indicating that it may be a key GP in regulation of the cardiac vagal activity.

中文翻译：

神经节丛消融序列对心脏神经消融过程中迷走神经反应、心率和血压的影响

宗旨

心脏神经消融术是治疗血管迷走性晕厥 (VVS) 的新兴且有前景的疗法。本研究旨在评估不同神经节神经丛（GPs）导管消融顺序的心脏神经消融术中迷走神经反应（VR）、心率（HR）和血压（BP）的特征，阐明心脏GPs的调节机制。的左心房。

方法

前瞻性纳入28例接受心脏神经消融术的VVS患者，并根据GP的消融顺序随机分为2组。A组：左上GP（LSGP）-左下GP（LIGP）-右下GP（RIGP）-右前GP（RAGP）；B组：RAGP - LSGP - LIGP - RIGP。

结果

在A组中，消融过程中LSGP、LIGP、RIGP和RAGP的VR分别在11例（78.6%）、5例（35.7%）、4例（28.6%）和2例（14.3%）病例中观察到。相比之下，在 B 组中，RAGP、LSGP、LIGP 和 RIGP 中的 VR 分别在 2 (14.3%)、1 (7.1%)、0 (0%) 和 0 (0%) 例中观察到。在 A 组和 B 组中分别观察到 8 次和 1 次手术过程中血压降低 ( P = 0.013)。在两组中，在消融 RAGP 期间 HR 显着增加（所有P < 0.001）。