PDF(Pubmed)
Abstract：
Cardioneuroablation (CNA) is currently considered as a promising treatment option for patients with symptomatic bradycardia caused by vagotonia. This study aims to further investigate its safety and efficacy in patients suffering from vagal bradycardia. A total of 60 patients with vagal bradycardia who underwent CNA in the First Affiliated Hospital of Xinjiang Medical University from November 2019 to June 2022. Preoperative atropine tests revealed abnormal vagal tone elevation in all patients. First, the electroanatomic structures of the left atrium was mapped out by using the Carto 3 system, according to the protocol of purely anatomy-guided and local fractionated intracardiac electrogram-guided CNA methods. The upper limit of ablation power of superior left ganglion (SLGP) and right anterior ganglion (RAGP) was not more than 45W with an ablation index of 450.Postoperative transesophageal cardiac electrophysiological examination was performed 1 to 3 months after surgery. The atropine test was conducted when appropriate. Twelve-lead electrocardiogram, Holter electrocardiogram, and skin sympathetic nerve activity were reviewed at 1, 3, 6 and 12 months after operation. Adverse events such as pacemaker implantation and other complications were also recorded to analyze the safety and efficacy of CNA in the treatment of vagus bradycardia. Sixty patients were enrolled in the study (38 males, mean age 36.67 ± 9.44, ranging from 18 to 50 years old). None of the patients had a vascular injury, thromboembolism, pericardial effusion, or other surgical complications. The mean heart rate, minimum heart rate, low frequency, low/high frequency, acceleration capacity of rate, and skin sympathetic nerve activity increased significantly after CNA. Conversely, SDNN, PNN50, rMSSD, high frequency, and deceleration capacity of rate values decreased after CNA (all P < 0.05). At 3 months after ablation, the average heart rate, maximum heart rate, and acceleration capacity of heart rate remained higher than those before ablation, and the deceleration capacity of heart rate remained lower than those before ablation and the above results continued to follow up for 12 months after ablation (all P < 0.05). There was no significant difference in other indicators compared with those before ablation (all P > 0.05). The remaining 81.67% (49/60) of the patients had good clinical results, with no episodes of arrhythmia during follow-up. CNA may be a safe and effective treatment for vagal-induced bradycardia, subject to confirmation by larger multicenter trials.
摘要：
心脏神经消融（CNA）目前被认为是由迷走神经引起的有症状的心动过缓患者的有希望的治疗选择。本研究旨在进一步研究其在迷走神经心动过缓患者中的安全性和有效性。选择2019年11月至2022年6月在新疆医科大学第一附属医院行CNA的迷走神经心动过缓患者60例。术前阿托品试验显示所有患者迷走神经张力异常升高。首先,使用Carto3系统绘制左心房的电解剖结构，根据纯解剖引导和局部分割心内电描记图引导CNA方法的协议。左上神经节（SLGP）和右前神经节（RAGP）消融功率上限不大于45W，消融指数为450。术后1～3个月行食管心脏电生理检查。适当时进行阿托品试验。十二导联心电图,Holter心电图,术后1、3、6、12个月复查皮肤交感神经活性。同时记录起搏器植入等不良事件,分析CNA治疗迷走神经心动过缓的安全性和有效性。该研究招募了60名患者（38名男性，平均年龄36.67±9.44，年龄从18岁到50岁）。没有一个病人有血管损伤,血栓栓塞,心包积液,或其他手术并发症。平均心率,最小心率,低频,低/高频率，速率的加速能力，CNA后皮肤交感神经活性明显增高。相反，SDNN,PNN50,rMSSD,高频,CNA后速率值的减速能力下降（均P<0.05）。消融后3个月，平均心率,最大心率,心率加速能力保持高于消融前，心率减速能力仍低于消融前，消融后随访12个月（均P<0.05）。其他指标与消融前比较差异均无统计学意义(均P>0.05)。其余81.67%(49/60)的患者临床效果良好,随访期间无心律失常发作。CNA可能是治疗迷走神经引起的心动过缓的一种安全有效的方法。有待更大的多中心试验确认。
