Cardioneuroablation for severe neurocardiogenic syncope

被引:7
作者
Silva, Gualter Santos [1 ]
Fonseca, Paulo [1 ]
Cardoso, Filipa [2 ]
Almeida, Joao [1 ]
Ribeiro, Silvia [2 ]
Oliveira, Marco [1 ]
Sanfins, Victor [2 ]
Goncalves, Helena [1 ]
Pachon, M. Jose Carlos [3 ]
Barra, Sergio [4 ]
Primo, Joao [1 ]
Lourenco, Antonio [2 ]
Fontes-Carvalho, Ricardo [1 ]
机构
[1] Ctr Hosp Vila Nova Gaia Espinho, Cardiol Dept, VN Gaia, Portugal
[2] Hosp Senhora Oliveira, Dept Cardiol, Guimaraes, Portugal
[3] Sao Paulo Heart Hosp HCor, Sao Paulo, Brazil
[4] Hosp Luz Arrabida, Cardiol Dept, VN Gaia, Portugal
关键词
Cardioneuroablation; Vasovagal syncope; Cardioinhibitory; Vagal denervation; FUNCTIONAL AV BLOCK; VASOVAGAL SYNCOPE; CATHETER ABLATION; VAGAL DENERVATION; PACEMAKER THERAPY; REFLEX; PREVENTION; SINUS; TRIAL; STIMULATION;
D O I
10.1016/j.repc.2023.02.012
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Introduction and objectives: Cardioneuroablation (CNA), a technique based on radiofrequency ablation of cardiac vagal ganglia, was developed to treat recurrent vasovagal syncope (VVS) with a predominant cardioinhibitory component, as an alternative to pacemaker implantation. The aim of our study was to evaluate the safety and success rate of CNA guided by extracardiac vagal stimulation in patients with highly symptomatic cardioinhibitory VVS.Methods: Prospective study of patients who underwent anatomically guided CNA at two cardiology centers. All patients had a history of recurrent syncope with a predominant cardioinhibitory component and refractory to conventional measures. Acute success was determined by the absence or significant reduction of cardiac parasympathetic response to extracardiac vagal stimulation. The primary endpoint was the recurrence of syncope during follow-up.Results: In total, 19 patients (13 males; mean age 37.8 + 12.9 years) were included. Ablation was acutely successful in all patients. One patient had a convulsive episode after the procedure, which was deemed unrelated to the ablation, requiring admission to intensive care but without sequelae. No other complications occurred. At a mean follow-up of 21.0 + 13.2 months (range 3--42 months), 17 patients remained free of syncope. The remaining two patients had recurrence of syncope and, despite undergoing a new ablation procedure, required pacemaker implantation during follow-up.Conclusion: Cardioneuroablation, confirmed by extracardiac vagal stimulation, appears to be an effective and safe treatment option for highly symptomatic patients with refractory VVS with a predominant cardioinhibitory component, providing a new potential approach as an alternative to pacemaker implantation.(c) 2023 Sociedade Portuguesa de Cardiologia. Published by Elsevier Espan similar to a, S.L.U. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/bync-nd/4.0/).
引用
收藏
页码:821 / 829
页数:9
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