Effects of left atrial ganglionated plexi denervation on cardiac deceleration capacity of patients with vasovagal syncope
Zheng Lihui, Sun Wei, Hu Feng, Liu Shangyu, Shen Lishui, Tu Bin, Li Jiakun, Zhang Zhenhao, Wu Lingmin, Yao Yan
Abstract
ObjectiveThis study used cardiac deceleration capacity (DC) index to evaluate the modification of left atrial (LA) ganglionated plexi (GP) denervation on cardiac autonomous innervation of vasovagal syncope (VVS) patients.
MethodsWe consecutively enrolled 45 drug-refractory VVS patients[age (41.3±14.2) years; 24 in female]from Fuwai Hospital, duriny May 2013 to January 2016. Catheter ablation was targeted at 5 LA GPs in all 45 patients. Overall DC, daytime DC (DDC) and nighttime DC (NDC) were regularly repeated after the procedure. Recurrent syncope events were documented during the follow-up period. Pearson’s correlation analysis was performed to evaluate the association between the inducibility of vagal response in each GP and DC. Repeated-measures ANOVA analysis was carried out to compare the differences of post-ablation overall DC, DDC and NDC in patients with or without recurrent syncope.
ResultsA total of 45 procedures were performed. In 38 patients vagal response was elicited and ablated in different GPs, including 38 left superior GP (LSGP) , 12 left lateral GP (LLGP) , 19 left inferior GP (LIGP) , 12 right inferior GP (RIGP) and 22 right anterior GP (RAGP) . There were 7 patients in whom none vagal response was induced in any GP site and these 7 patients experienced recurrent syncope after the procedure. According to Pearson’s correlation analysis, the inducibility of vagal response in each GP site demonstrated no correlation with baseline overall DC, DDC and NDC (P<0.05) . Meanwhile, vagal response induced in LSGP was negatively correlated with post-ablation overall DC, DDC and NDC in different follow-up points (P<0.05, respectively) while RAGP vagal response was only negatively associated with the 1-day post-ablation overall DC and DDC (P<0.05, respectively) . Analysis of variance revealed that post-ablation overall DC, DDC and NDC differed significantly between patients with recurrent syncope and patients without recurrent syncope in each follow-up points (P<0.05) .
ConclusionLA GP denervation prevented the majority of VVS recurrence. The treatment demonstrated significant impact on the cardiac autonomous nerve system. LSGP and RAGP may play the crucial role on the modification of parasympathetic nerve system.
Key words:
Catheter ablation; Vasovagal syncope; Left atrium; Ganglionated plexi; Deceleration capacity
Contributor Information
Zheng Lihui
Center of Arrhythmia, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, China
Sun Wei
Center of Arrhythmia, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, China
Hu Feng
Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200127, China
Liu Shangyu
Center of Arrhythmia, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, China
Shen Lishui
Center of Arrhythmia, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, China
Tu Bin
Center of Arrhythmia, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, China
Li Jiakun
Center of Arrhythmia, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, China
Zhang Zhenhao
Center of Arrhythmia, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, China
Wu Lingmin
Center of Arrhythmia, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, China
Yao Yan
Center of Arrhythmia, Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing 100037, China
