María Teresa Barrio-Lopez, Carlos Álvarez-Ortega, Carlos Minguito-Carazo, Eduardo Franco, Pablo Elpidio García-Granja, Óscar Alcalde-Rodríguez, Óscar Salvador-Montañés, Jaume Francisco-Pascual, Rosa Macías-Ruíz, Álvaro Marco Del Castillo, Sebastián Giacoman-Hernández, Víctor Expósito-García, Eusebio Garcia-Izquierdo, Juan Manuel Durán, Naiara Calvo-Galiano, José Luis Ibáñez-Criado, Enrique García-Cuenca, Sofia Calero, Javier Fernandez-Portales, Markus Linhart, Moises Rodriguez-Mañero, Jesús Daniel Martínez-Alday, Damian Sanchez-Quintana, Jesús Almendral-Garrote, Ángel Moya-Mitjáns
{"title":"晕厥患者心脏神经消融术临床成功的预测因素:一项多中心研究的结果","authors":"María Teresa Barrio-Lopez, Carlos Álvarez-Ortega, Carlos Minguito-Carazo, Eduardo Franco, Pablo Elpidio García-Granja, Óscar Alcalde-Rodríguez, Óscar Salvador-Montañés, Jaume Francisco-Pascual, Rosa Macías-Ruíz, Álvaro Marco Del Castillo, Sebastián Giacoman-Hernández, Víctor Expósito-García, Eusebio Garcia-Izquierdo, Juan Manuel Durán, Naiara Calvo-Galiano, José Luis Ibáñez-Criado, Enrique García-Cuenca, Sofia Calero, Javier Fernandez-Portales, Markus Linhart, Moises Rodriguez-Mañero, Jesús Daniel Martínez-Alday, Damian Sanchez-Quintana, Jesús Almendral-Garrote, Ángel Moya-Mitjáns","doi":"10.1016/j.jacep.2024.07.027","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Cardioneuroablation (CNA) is a promising treatment for syncope.</p><p><strong>Objectives: </strong>This study sought to analyze the success and risk of CNA ,and to describe predictive factors of CNA success in patients with syncope.</p><p><strong>Methods: </strong>Seventy-seven consecutive patients with syncope treated with CNA in 22 hospitals and at least 6 months of follow-up were included. Patients with reflex cardioinhibitory, mixed syncope, functional sinus node dysfunction (SND), or functional atrioventricular block were included. The primary endpoint was the recurrence of syncope after the CNA.</p><p><strong>Results: </strong>Mean age was 49.3 ± 13.4 years and 54.5% were women. Five (6.5%) patients presented complications. Three patients presented SND, 1 required a pacemaker. During a median follow-up of 12 months (Q1-Q3: 8-20 months), 26 (33.8%) patients had recurrence of syncope. Women had a significantly higher risk of recurrence compared with men (HR: 3.3; 95% CI: 1.2-8.8; P = 0.016). Patients >50 years of age had a significantly lower risk of recurrence compared with younger patients (HR: 0.3; 95% CI: 0.1-0.9; P = 0.032). The risk of recurrence in mixed syncope was significantly higher than in cardioinhibitory syncope (HR: 4.4; 95% CI: 1.1-17.5; P = 0.033). Syncope recurrence was significantly less frequent in patients treated with general anesthesia or deep sedation compared with conscious sedation (HR: 0.2; 95% CI: 0.1-0.6; P = 0.002). Finally, the number of radiofrequency applications (≤30 or >30) had a significant association with CNA success (HR: 0.4; 95% CI: 0.2-0.9; P = 0.042). These results were adjusted for confounding factors.</p><p><strong>Conclusions: </strong>In this multicenter study, the effectiveness of CNA was less than previously reported. We found a 3.9% risk of SND. Male sex, age >50 years, cardioinhibitory syncope, general anesthesia or deep sedation, and >30 radiofrequency applications could predict success of CNA for syncope.</p>","PeriodicalId":14573,"journal":{"name":"JACC. 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Patients with reflex cardioinhibitory, mixed syncope, functional sinus node dysfunction (SND), or functional atrioventricular block were included. The primary endpoint was the recurrence of syncope after the CNA.</p><p><strong>Results: </strong>Mean age was 49.3 ± 13.4 years and 54.5% were women. Five (6.5%) patients presented complications. Three patients presented SND, 1 required a pacemaker. During a median follow-up of 12 months (Q1-Q3: 8-20 months), 26 (33.8%) patients had recurrence of syncope. Women had a significantly higher risk of recurrence compared with men (HR: 3.3; 95% CI: 1.2-8.8; P = 0.016). Patients >50 years of age had a significantly lower risk of recurrence compared with younger patients (HR: 0.3; 95% CI: 0.1-0.9; P = 0.032). The risk of recurrence in mixed syncope was significantly higher than in cardioinhibitory syncope (HR: 4.4; 95% CI: 1.1-17.5; P = 0.033). Syncope recurrence was significantly less frequent in patients treated with general anesthesia or deep sedation compared with conscious sedation (HR: 0.2; 95% CI: 0.1-0.6; P = 0.002). Finally, the number of radiofrequency applications (≤30 or >30) had a significant association with CNA success (HR: 0.4; 95% CI: 0.2-0.9; P = 0.042). These results were adjusted for confounding factors.</p><p><strong>Conclusions: </strong>In this multicenter study, the effectiveness of CNA was less than previously reported. We found a 3.9% risk of SND. Male sex, age >50 years, cardioinhibitory syncope, general anesthesia or deep sedation, and >30 radiofrequency applications could predict success of CNA for syncope.</p>\",\"PeriodicalId\":14573,\"journal\":{\"name\":\"JACC. 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Predictors of Clinical Success of Cardioneuroablation in Patients With Syncope: Results of a Multicenter Study.
Background: Cardioneuroablation (CNA) is a promising treatment for syncope.
Objectives: This study sought to analyze the success and risk of CNA ,and to describe predictive factors of CNA success in patients with syncope.
Methods: Seventy-seven consecutive patients with syncope treated with CNA in 22 hospitals and at least 6 months of follow-up were included. Patients with reflex cardioinhibitory, mixed syncope, functional sinus node dysfunction (SND), or functional atrioventricular block were included. The primary endpoint was the recurrence of syncope after the CNA.
Results: Mean age was 49.3 ± 13.4 years and 54.5% were women. Five (6.5%) patients presented complications. Three patients presented SND, 1 required a pacemaker. During a median follow-up of 12 months (Q1-Q3: 8-20 months), 26 (33.8%) patients had recurrence of syncope. Women had a significantly higher risk of recurrence compared with men (HR: 3.3; 95% CI: 1.2-8.8; P = 0.016). Patients >50 years of age had a significantly lower risk of recurrence compared with younger patients (HR: 0.3; 95% CI: 0.1-0.9; P = 0.032). The risk of recurrence in mixed syncope was significantly higher than in cardioinhibitory syncope (HR: 4.4; 95% CI: 1.1-17.5; P = 0.033). Syncope recurrence was significantly less frequent in patients treated with general anesthesia or deep sedation compared with conscious sedation (HR: 0.2; 95% CI: 0.1-0.6; P = 0.002). Finally, the number of radiofrequency applications (≤30 or >30) had a significant association with CNA success (HR: 0.4; 95% CI: 0.2-0.9; P = 0.042). These results were adjusted for confounding factors.
Conclusions: In this multicenter study, the effectiveness of CNA was less than previously reported. We found a 3.9% risk of SND. Male sex, age >50 years, cardioinhibitory syncope, general anesthesia or deep sedation, and >30 radiofrequency applications could predict success of CNA for syncope.
期刊介绍:
JACC: Clinical Electrophysiology is one of a family of specialist journals launched by the renowned Journal of the American College of Cardiology (JACC). It encompasses all aspects of the epidemiology, pathogenesis, diagnosis and treatment of cardiac arrhythmias. Submissions of original research and state-of-the-art reviews from cardiology, cardiovascular surgery, neurology, outcomes research, and related fields are encouraged. Experimental and preclinical work that directly relates to diagnostic or therapeutic interventions are also encouraged. In general, case reports will not be considered for publication.