| Objective: Vasovagal syncope(VVS)is a transient loss of consciousness caused by cerebral hypoperfusion due to disturbance of autonomic innervation.At present,physical therapy and drug therapy for VVS are not effective.Cardioneuroablation(CNA)is a relatively new treatment strategy to improve and prevent syncope by ablation of ganglionated plexi(GP).The aim of this study is to evaluate the therapeutic effect of CNA on different types of VVS patients through long-term follow-up after CNA,and to find a feasible and effective way for clinical treatment of VVS.Methods: A total of 35 patients with VVS who were hospitalized in the Department of Cardiology of Jiangxi Provincial People’s Hospital from July 2020 to July 2022 were collected.Syncope caused by other reasons and organic cardiac diseases were excluded.The VVS patients were classified by different hemodynamic changes during a positive Head-Up Tilt Testing(HUTT).Holter monitoring was performed before and after ablation.The changes of heart rate and Venn’s point of atrioventricular conduction were compared before and after ablation.The results of24-hour dynamic electrocardiogram were recorded at 3 months after operation to evaluate the safety and efficacy of CNA in the treatment of VVS,and the efficacy of CNA in different types of VVS was compared.Results:(1)35 patients were enrolled,including 18 males and 17 females,with an average age of(47.79±16.49)years.The duration of syncope was 24.0(2.5,66.0)months,and the number of syncope was 2.0(2.0,4.0)times.There were 19 cases(54.29%)of mixed type,13 cases(37.14%)of vasodepressor type and 3 cases(8.57%)of cardioinhibitor type.(2)All patients with VVS achieved the clinical ablation endpoint.Among the 19 patients with mixed VVS,vagal responses were observed in 19 cases(100%),17cases(89.47%),8 cases(42.11%),16 cases(84.21%)and 18 cases(94.74%)at left superior GP,left inferior GP,left posterolateral GP,right anterior GP and right inferior GP,respectively.Among the 13 patients with vasodepressor VVS,vagal responses were observed in 12 cases(92.30%),12 cases(92.30%),5 cases(38.46%),13 cases(100%)and 12 cases(92.30%)at left superior GP,left inferior GP,left posterior medial GP,right anterior GP and right inferior GP,respectively.There was no significant difference between the two groups(P > 0.05).Among the five common GPs during CNA treatment,the left superior GP and the right anterior GP were the GPs with the highest positive rate of vagal reaction.(3)Compared with the baseline parameters,the heart rate of all patients increased significantly and the Venn’s point of atrioventricular conduction decreased significantly after CNA(P < 0.05).(4)Among the time domain indexes of heart rate variability,the average heart rate,maximum heart rate and minimum heart rate at 3 months after CNA were significantly higher than those before CNA(P < 0.05).The time domain indexes of heart rate variability(HRV)at 3 months after operation were lower than those before operation,and the difference was statistically significant(P < 0.05).(5)During a mean follow-up of 11±4.67 months,recurrent syncope occurred in2 patients with vasodepressor VVS,1 patient with prodromes,and 1 patient with mixed VVS,and no patient with prodromes.No serious complications were observed.There was no significant difference in the long-term efficacy between mixed VVS and vasodepressor VVS patients treated with CNA(P > 0.05).Conclusion: CNA is an effective treatment for VVS.The heart rate of the patients was significantly increased after ablation,and the time domain index of heart rate variability after ablation was lower than that before ablation,indicating that surgical ablation can improve the function of vagal nerve,thereby preventing the attack of syncope.Through long-term follow-up,CNA has a good long-term effect on the treatment of mixed and vasodepressor VVS.The results of this study can provide a theoretical basis for the development of treatment strategies for patients with mixed and vasodepressor VVS in clinical practice. |
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