| Background:Vasovagal syncope(VVS)is a neuroreflex syncope caused by abnormal autonomic nervous function,which is the most common type of syncope in clinic.It is estimated that 20%to 40%of the population will experience at least one episode of VVS in their lifetime.VVS accounts for 40%-60%of emergency syncope patients and up to 80%of children with unexplained syncope.The prognosis for VVS patients is good,but repeated episodes of syncope can cause significant psychological distress and reduce patients’ability to perform daily activities.Therefore,active diagnosis and treatment strategies are necessary to improve patients’ quality of life.Typical VVS are triggered by abnormal sympathetic reduction and/or abnormal activation of the vagus nerve,and abnormal autonomic nerve causes a sudden decrease in heart rate and blood pressure,resulting in systemic circulatory hypoperfusion,especially cerebral hypoperfusion,which is the direct cause of the loss of consciousness in the patients.Typical VVS patients have significant clinical features and can be diagnosed according to the characteristics of the patient’s medical history.However,the diagnosis of patients with atypical VVS is difficult,and the diagnostic value of auxiliary examinations such as tilt test is limited,lacking indicators or evidence to provide direct diagnostic basis.In the treatment of VVS,non-drug therapy such as patient education and improvement of living habits is the basis of VVS treatment,and drug therapy and pacemaker therapy should be carefully considered according to clinical conditions.Compared with the above traditional treatments,cardioneuroablation therapy directly targets the ganglion plexus on the surface of the heart,and the long-term treatment success rate is more than 90%.Solving the problems of patient selection and ablation strategy of this procedure is the basis for the application and promotion of this treatment program.This study aimed to investigate the risk factors of VVS patients compared with healthy people,and to evaluate the diagnostic value of autonomic nervous system evaluation indexes for VVS.To analyze the physiological characteristics of the autonomic nerve regulating the heart rate change in VVS patients,so as to seek more understanding of this disease.To investigate autonomic nerve assessment indexes in relation to ablation and recurrence in cardioneuroablation patients with refractory vasovagal syncope.Part one:Application of deceleration capacity combined with deceleration runs in diagnosis of vasovagal syncopeObjectives This study aimed to investigate the risk factors of VVS patients compared with healthy people,and to evaluate the diagnostic value of autonomic nervous system evaluation indexes for VVS.To analyze the physiological characteristics of the autonomic nerve regulating the heart rate change in VVS patients,so as to seek more understanding of this disease.Methods A total of 188 patients with definite diagnosis of VVS admitted to our hospital from August 2017 to June 2020 were continuously enrolled,and 132 healthy subjects were included as control group.Baseline data,24-hour Holter test data,heart rate deceleration capacity(DC)and heart rate deceleration runs(DRs)of the two groups were compared.The risk factors of VVS patients compared with healthy people were evaluated by Logistics regression analysis.Results VVS patients had higher DC(10.63±2.1 ms vs.6.58±1.7 ms,P<0.001)and lower DR6-10 than controls.In multivariate logistic regression,DC(OR 1.541;95%CI 1.173-2.024;P=0.01),VLDR(OR 5.614;95%CI 1.486-9.771;P<0.001)and the minimum heart rate(OR=0.946,95%CI 0.897-0.998;P=0.041)were independent predictors for syncope.Various models,such as DC,DC combined minimum heart rate and DC combined VLDR,were applied to the diagnosis of VVS.Among them,the area under curve(AUC)analysis showed similar values when comparing DC alone and DC combined with VLDR(P=0.216).The specificity of DC combined with the VLDR was significantly higher than that of the DC-only model(0.879 vs.0.681,P<0.01).Conclusion In VVS patients,DC combined with DRs revealed a better ability for quantification of vagal modulation,thus may further improve VVS diagnosis.Part two:Application of deceleration capacity combined with deceleration runs in cardioneuroablation in patients with refractory vasovagal syncopeObjectives This study was to investigate autonomic nerve assessment indexes in relation to ablation and recurrence in cardioneuroablation patients with refractory vasovagal syncope.Methods One hundred and forty-seven patients with refractory VVS who underwent cardiac nerve ablation in our hospital from August 2017 to June 2020 were consecutively enrolled,and the differences of heart rate variability,DC and DRs were compared between patients with and without recurrence after ablation.Results 1)Compared with the non-recurrence group,the proportion of male patients in the recurrence group was lower(50.1%vs 26.3%,p=0.012);Patients had lower systolic blood pressure(122±14mmHg vs 115±16mmHg,p=0.004).2)Compared with the non-recurrence group,the all-day DC(10.3±3.1ms vs 8.3±4.0ms,p=0.008)and daytime DC(10.1 ±3.1ms vs 8.0±4.1ms,p=0.001)in the recurrence group,The night DC(11.5±3.3ms vs 9.8±3.7ms,p=0.02)was significantly lower.3)There was no significant difference in the relevant indexes of heart rate variability in time domain analysis and frequency domain analysis between the two groups.There was no significant difference in heart rate deceleration runs between the two groups.Multiple logistic regression analysis showed that gender,systolic blood pressure and daytime DC were independent risk factors for syncope/presyncope recurrence after ablation.Conclusion The DC of patients in the relapsed group was significantly lower than that in the non-relapsed group,indicating that there were differences in vagus nerve activity among patients with VVS.There was no significant difference in HRV and DRs between the two groups,suggesting that various methods of autonomic nervous function assessment have their own advantages and complement each other. |
PDF Full Text Request