Abstract：
OBJECTIVE: Prior case series showed promising results for cardioneuroablation in patients with vagally induced atrioventricular blocks (VAVBs). We aimed to examine the acute procedural characteristics and intermediate-term outcomes of electroanatomical-guided cardioneuroablation (EACNA) in patients with VAVB.
RESULTS: This international multicentre retrospective registry included data collected from 20 centres. Patients presenting with symptomatic paroxysmal or persistent VAVB were included in the study. All patients underwent EACNA. Procedural success was defined by the acute reversal of atrioventricular blocks (AVBs) and complete abolition of atropine response. The primary outcome was occurrence of syncope and daytime second- or advanced-degree AVB on serial prolonged electrocardiogram monitoring during follow-up. A total of 130 patients underwent EACNA. Acute procedural success was achieved in 96.2% of the cases. During a median follow-up of 300 days (150, 496), the primary outcome occurred in 17/125 (14%) cases with acute procedural success (recurrence of AVB in 9 and new syncope in 8 cases). Operator experience and use of extracardiac vagal stimulation were similar for patients with and without primary outcomes. A history of atrial fibrillation, hypertension, and coronary artery disease was associated with a higher primary outcome occurrence. Only four patients with primary outcome required pacemaker placement during follow-up.
CONCLUSIONS: This is the largest multicentre study demonstrating the feasibility of EACNA with encouraging intermediate-term outcomes in selected patients with VAVB. Studies investigating the effect on burden of daytime symptoms caused by the AVB are required to confirm these findings.
RESULTS: This international multicentre retrospective registry included data collected from 20 centres. Patients presenting with symptomatic paroxysmal or persistent VAVB were included in the study. All patients underwent EACNA. Procedural success was defined by the acute reversal of atrioventricular blocks (AVBs) and complete abolition of atropine response. The primary outcome was occurrence of syncope and daytime second- or advanced-degree AVB on serial prolonged electrocardiogram monitoring during follow-up. A total of 130 patients underwent EACNA. Acute procedural success was achieved in 96.2% of the cases. During a median follow-up of 300 days (150, 496), the primary outcome occurred in 17/125 (14%) cases with acute procedural success (recurrence of AVB in 9 and new syncope in 8 cases). Operator experience and use of extracardiac vagal stimulation were similar for patients with and without primary outcomes. A history of atrial fibrillation, hypertension, and coronary artery disease was associated with a higher primary outcome occurrence. Only four patients with primary outcome required pacemaker placement during follow-up.
CONCLUSIONS: This is the largest multicentre study demonstrating the feasibility of EACNA with encouraging intermediate-term outcomes in selected patients with VAVB. Studies investigating the effect on burden of daytime symptoms caused by the AVB are required to confirm these findings.
摘要：
目的：先前病例系列显示了迷走神经诱发房室传导阻滞（VAVBs）患者的心脏神经消融的良好结果。我们旨在研究VAVB患者的电解剖引导下心脏神经消融（EACNA）的急性手术特征和中期结局。
结果：这项国际多中心回顾性注册包括从20个中心收集的数据。出现症状性阵发性或持续性VAVB的患者被纳入研究。所有患者均接受EACNA治疗。手术成功取决于房室传导阻滞（AVB）的急性逆转和阿托品反应的完全消除。主要结果是在随访期间连续延长的心电图监测中出现晕厥和白天二级或晚期AVB。共有130名患者接受了EACNA。96.2％的病例获得了急性手术成功。在300天的中位随访期间（150，496），主要结局发生在17/125(14%)急性手术成功的病例中(9例AVB复发,8例新发晕厥).对于有和没有主要结局的患者，操作员经验和心外迷走神经刺激的使用相似。房颤病史,高血压,冠状动脉疾病与较高的主要结局发生率相关。在随访期间，只有四名具有主要结局的患者需要放置起搏器。
结论：这是最大的多中心研究，证明了EACNA在选定的VAVB患者中具有令人鼓舞的中期结局的可行性。需要调查AVB对白天症状负担的影响的研究来证实这些发现。
结果：这项国际多中心回顾性注册包括从20个中心收集的数据。出现症状性阵发性或持续性VAVB的患者被纳入研究。所有患者均接受EACNA治疗。手术成功取决于房室传导阻滞（AVB）的急性逆转和阿托品反应的完全消除。主要结果是在随访期间连续延长的心电图监测中出现晕厥和白天二级或晚期AVB。共有130名患者接受了EACNA。96.2％的病例获得了急性手术成功。在300天的中位随访期间（150，496），主要结局发生在17/125(14%)急性手术成功的病例中(9例AVB复发,8例新发晕厥).对于有和没有主要结局的患者，操作员经验和心外迷走神经刺激的使用相似。房颤病史,高血压,冠状动脉疾病与较高的主要结局发生率相关。在随访期间，只有四名具有主要结局的患者需要放置起搏器。
结论：这是最大的多中心研究，证明了EACNA在选定的VAVB患者中具有令人鼓舞的中期结局的可行性。需要调查AVB对白天症状负担的影响的研究来证实这些发现。
