Senkop Şikayeti ile Başvuran Hastalarda Yapılan Kardiyonöromodulasyon İşleminin Kısa ve Uzun Dönem Sonuçlarının Değerlendirilmesi
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Tarih
2024Yazar
AYGÜN, Dr. Sevda
Ambargo Süresi
Acik erisimÜst veri
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AYGUN S., Evaluation of Short-Term and Long-Term Results of
Cardioneuromodulation Procedure in Patients Presenting with Syncope,
Hacettepe University Faculty of Medicine, Thesis in Cardiology, Ankara, 2024.
Vasovagal syncope commonly affects young individuals. In recent years, the
endocardial ablation of cardiac parasympathetic ganglion plexi, termed
"cardioneuromodulation (CNM)," has emerged as a novel therapeutic approach. This
study aims to evaluate the efficacy and safety of CNM in patients presenting with
syncope. Fifty-seven patients who presented with syncope to the Hacettepe
University Cardiology Clinic and underwent KNM between October 2019 and
August 2023 were included. All patients had a positive cardioinhibitory tilt table test.
Pre- and post-procedural rhythm Holter recordings were examined. Intracardiac
electrogram (EGM) measurements and standard electrophysiological study
parameters during and after the procedure were analyzed to determine the endpoints
and efficacy of KNM. Symptoms and complications were assessed for three times
during 1 year follow-up (0-4 months, 5-8 months, and 9-12 months). The mean
number of syncopal episodes was 2.68±1.58 before the procedure and 0.28±0.56 at
the one-year follow-up (Z=-6.359, p<0.001). During follow-up, 14 patients (24.5%)
experienced a syncope episode. Syncope was reported by 2 patients (3.5%) at the
first follow-up, 7 patients (12.3%) at the second follow-up, and 10 patients (17.5%)
at the third follow-up. The post-procedural P-P interval reduction percentage and
heart rate increase percentage values were significantly higher in the non-recurrent
group compared to the group with recurrence (p<0.05). Subgroup analyses were
conducted by dividing the patient population into three groups: those with
recurrence, those without recurrence and any complaints, and those without
recurrence but with palpitations. Specifically, the percentage reduction in P-P
intervals was 21.9%, 23.2%, and 26.5% (F=4.086; p=0.022) and the percentage
increase in heart rate was 23.9%, 32.1%, and 38.8% (F=3.971; p=0.025) in the
recurrence, non-recurrence and complaint, and non-recurrence with palpitations
groups, respectively. Procedural data indicated that the number of ablation lesions
(F=7.125; p=0.002), average impedance drop (F=4.184; p=0.020), lesion area
(χ2=11.028; p=0.004), and RF duration (F=3.343; p=0.043) were significantly higher
in the non-recurrence but palpitations group compared to the other two groups. The
study results indicate that KNM substantially reduces the number of syncopal
episodes at one-year follow-up. Based on our findings, targeting a P-P interval
increase percentage between 23% and 26.5% and a heart rate increase percentage
between 32.2% and 38.8% may provide a safe zone to prevent both syncope
recurrence and palpitations. However, large-scale, prospective, randomized studies
are needed to identify all factors affecting procedural success and syncope
recurrence, establish a standard ablation endpoint for adequate vagal denervation,
and incorporate these findings into routine clinical practice.
Keywords: Syncope, Recurrence, Cardioneuromodulation