Effectiveness of cardioneuroablation in different subtypes of vasovagal syncope.

IF 1.8 4区医学 Q3 CARDIAC & CARDIOVASCULAR SYSTEMS Journal of Geriatric Cardiology Pub Date : 2024-06-28 DOI:10.26599/1671-5411.2024.06.004

Bin Tu, Zi-Hao Lai, Ai-Yue Chen, Zhi-Yuan Weng, Si-Min Cai, Zhu-Xin Zhang, Li-Kun Zhou, Li-Hui Zheng, Yan Yao

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Abstract

Background: Cardioneuroablation (CNA) has shown encouraging results in patients with vasovagal syncope (VVS). However, data on different subtypes was scarce.

Methods: This observational study retrospectively enrolled 141 patients [mean age: 40 ± 18 years, 51 males (36.2%)] with the diagnosis of VVS. The characteristics among different types of VVS and the outcomes after CNA were analyzed.

Results: After a mean follow-up of 4.3 ± 1.5 years, 41 patients (29.1%) experienced syncope/pre-syncope events after CNA. Syncope/pre-syncope recurrence significantly differed in each subtype (P = 0.04). The cardioinhibitory type of VVS had the lowest recurrence rate after the procedure (n = 6, 16.7%), followed by mixed (n = 26, 30.6%) and vasodepressive (n = 9, 45.0%). Additionally, a significant difference was observed in the analyses of the Kaplan-Meier survival curve (P = 0.02). Syncope/pre-syncope burden was significantly reduced after CNA in the vasodepressive type (P < 0.01). Vasodepressive types with recurrent syncope/pre-syncope after CNA have a lower baseline deceleration capacity (DC) level than those without (7.4 ± 1.0 ms vs. 9.0 ± 1.6 ms, P = 0.01). Patients with DC < 8.4 ms had an 8.1 (HR = 8.1, 95% CI: 2.2-30.0, P = 0.02) times risk of syncope/pre-syncope recurrence after CNA compared to patients with DC ≥ 8.4 ms, and this association still existed after adjusting for age and sex (HR = 8.1, 95% CI: 2.2-30.1, P = 0.02).

Conclusions: Different subtypes exhibit different event-free rates. The vasodepressive type exhibited the lowest event-free rate, but those patients with DC ≥ 8.4 ms might benefit from CNA.

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对不同亚型的血管迷走性晕厥进行心脏神经消融术的效果。

背景：心脏血管神经消融术（CNA）在血管迷走性晕厥（VVS）患者中取得了令人鼓舞的效果。然而，有关不同亚型的数据却很少：这项观察性研究回顾性地纳入了 141 名被诊断为 VVS 的患者[平均年龄：40 ± 18 岁，51 名男性（36.2%）]。分析了不同类型 VVS 的特征以及 CNA 后的结果：平均随访 4.3 ± 1.5 年后，41 名患者（29.1%）在 CNA 后出现晕厥/晕厥前事件。每个亚型的晕厥/晕厥前症状复发率均有显著差异（P = 0.04）。心抑制型 VVS 术后复发率最低（6 人，16.7%），其次是混合型（26 人，30.6%）和血管抑制型（9 人，45.0%）。此外，Kaplan-Meier 生存曲线分析也发现了明显差异（P = 0.02）。血管抑郁型患者在接受 CNA 治疗后，晕厥/晕厥前负担明显减轻（P < 0.01）。CNA 后复发晕厥/晕厥前症的血管抑郁型患者的基线减速能力（DC）水平低于非血管抑郁型患者（7.4 ± 1.0 ms vs. 9.0 ± 1.6 ms，P = 0.01）。DC<8.4毫秒的患者与DC≥8.4毫秒的患者相比，CNA后晕厥/晕厥前症状复发的风险是后者的8.1倍（HR = 8.1，95% CI：2.2-30.0，P = 0.02），调整年龄和性别后，这种关联仍然存在（HR = 8.1，95% CI：2.2-30.1，P = 0.02）：不同亚型表现出不同的无事件发生率。血管抑郁型的无事件发生率最低，但 DC≥8.4 ms 的患者可能会从 CNA 中获益。

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来源期刊

Journal of Geriatric Cardiology CARDIAC & CARDIOVASCULAR SYSTEMS-GERIATRICS & GERONTOLOGY

CiteScore

3.30

自引率

4.00%

发文量

1161

期刊介绍： JGC focuses on both basic research and clinical practice to the diagnosis and treatment of cardiovascular disease in the aged people, especially those with concomitant disease of other major organ-systems, such as the lungs, the kidneys, liver, central nervous system, gastrointestinal tract or endocrinology, etc.