背景:心脏神经消融术(CNA)是一种有前途的治疗反射性气滞性晕厥的方法,然而,目前仍缺乏有关该手术中期安全性和有效性的令人信服的数据.
目的:为了评估中期安全性,CNA的疗效和患者的接受度。
方法:这项前瞻性观察性单中心研究包括115名连续患者(平均39±13年,58%的女性)在2016年至2022年之间接受治疗,完成了至少一年的随访。
结果:没有明显的手术相关急性并发症。在28个月的中位随访期间(范围12-75),95(83%)没有晕厥。在20例(17%)晕厥复发患者中,晕厥负担从平均17(中位数6.5)降低到3.75(中位数2.5)(p=0.015)。在10例患者中,有9例可以移除起搏系统。3例(3%)患者需要重复CNA,而5例(4%)患者需要植入起搏器。CNA最常见的中期并发症是窦性心律加速(从60±14到90±16bpm(p<0.0001),31(27%)例患者有症状;8(7%)例患者需要慢性β受体阻滞剂和/或伊伐布雷定。窦房结修饰是必要的。其他投诉包括呼吸困难,慢性胸痛和运动能力下降,轻度,16例(14%)患者报告。患者对CNA的接受度非常高-96%表示值得接受该程序。
结论:CNA中期疗效超过80%,且无急性并发症。最常见的中期慢性并发症是不适当的窦性心动过速,其中7%需要长期治疗。该程序为患者所接受。
BACKGROUND: Cardioneuroablation (CNA) is a promising therapy for reflex asystolic syncope; however, convincing data on the mid-term safety and efficacy of this procedure are lacking.
OBJECTIVE: The purpose of this study was to assess the mid-term safety, efficacy, and patient acceptance of CNA.
METHODS: This prospective observational single-center study included 115 consecutive patients (mean age 39 ± 13 years; 58% female) treated between 2016 and 2022 who completed at least 1-year follow-up.
RESULTS: No significant procedure-related acute complications occurred. During median follow-up of 28 months (range 12-75), 95 (83%) remained free from syncope. Of the 20 patients (17%) with syncope recurrence, syncope burden decreased from a mean 17 (median 6.5) to 3.75 (median 2.5) episodes (P = .015). In 9 of 10 patients, pacing system removal was possible. Repeated CNA was needed in 3 patients (3%), whereas pacemaker implantation was performed in 5 (4%). The most frequent mid-term complication of CNA was sinus rhythm acceleration (from 60 ± 14 bpm to 90 ± 16 bpm; P <.0001), which was symptomatic in 31 patients (27%); 8 patients (7%) required chronic beta-blocker and/or ivabradine. Sinus node modification was necessary in 1 patient. Other complaints included dyspnea, chronic chest pain, and decreased exercise capacity, which were mild and reported by 16 patients (14%). Patient acceptance of CNA was very high: 96% stated that it was worth undergoing the procedure.
CONCLUSIONS: Mid-term efficacy of CNA exceeds 80%, and acute complications are absent. The most frequent mid-term chronic complication is inappropriate sinus tachycardia, which in 7% required chronic treatment. The procedure is well accepted by patients.