Background

Cardioneuroablation (CNA) has been recently proposed as a new therapy in patients with asystolic vasovagal syncope (VVS) caused by parasympathetic overactivity.

Objective

To assess the impact of CNA on the type of VV response during tilt testing (TT).

Methods

The study group consisted of 20 patients (7 males, mean age 38 ± 9). All patients had a history of syncope due to asystole and confirmed asystolic VVS at baseline TT (TT₁). CNA was performed in the right and left atrium. The second TT (TT₂) and Holter ECG were performed three months later. All patients completed one-year follow up.

Results

At TT₁, twenty patients had cardioinhibitory syncope and 1 had mixed VVS with asystole > 3 s. During one-year follow-up no spontaneous syncopal episodes were noted. At TT2, 6 patients had no syncope whereas the remaining 13 had syncope – twelve due to vasodepressor mechanism and only one due to asystole. Mean heart rate after CNA was significantly faster and heart rate variability parameter (SDNN) lower than before the procedure (82 ± 9 vs 69 ± 11 beats/min, p = 0.0003 and 74 ± 22 vs 143 ± 40 ms, p = 000001, respectively). These changes were similar in those who fainted during TT₂ and those who did not (84 ± 10 vs 81 ± 5 beats/min, p = NS and 72 ± 24 vs 72 ± 19 ms, p = NS, respectively).

Conclusions

CNA profoundly affects type of VV reaction causing normalization of the response to tilting or changing cardiodepression to vasodepression. Changes in heart rate and heart rate variability are consistent with attenuation of parasympathetic activity.

中文翻译：

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心脏神经消融改变收缩期反射性晕厥患者血管迷走神经反应的类型

背景

心脏神经消融术 (CNA) 最近被提议作为一种新疗法，用于治疗由副交感神经过度活动引起的收缩性血管迷走性晕厥 (VVS) 患者。

客观的

评估 CNA 对倾斜测试 (TT) 期间 VV 响应类型的影响。

方法

研究组由 20 名患者（7 名男性，平均年龄 38 ± 9 岁）组成。所有患者都有因心搏停止而导致的晕厥病史，并且在基线 TT (TT ₁ ) 时确认了心搏停止 VVS 。CNA 在左右心房进行。三个月后进行了第二次 TT (TT ₂ ) 和 Holter ECG。所有患者均完成了一年的随访。

结果

在 TT _{1 时}，20 名患者出现心脏抑制性晕厥，1 名患者出现混合性 VVS，心搏停止 > 3 秒。在一年的随访期间，没有发现自发性晕厥发作。在 TT2，6 名患者没有晕厥，而其余 13 名患者出现晕厥——12 名是由于血管减压机制，只有 1 名是由于心搏停止。CNA 后的平均心率明显加快，心率变异性参数 (SDNN) 低于手术前（82 ± 9 vs 69 ± 11 次/分钟，p = 0.0003 和 74 ± 22 vs 143 ± 40 ms，p = 000001，分别）。这些变化在 TT ₂期间晕倒的人和没有晕倒的人中相似（分别为 84 ± 10 对 81 ± 5 次/分钟，p = NS 和 72 ± 24 对 72 ± 19 毫秒，p = NS）。

结论

CNA 深刻影响 VV 反应的类型，导致对倾斜或将心脏抑制转变为血管抑制的反应正常化。心率和心率变异性的变化与副交感神经活动的减弱一致。