Clinical impact of aging on outcomes of cardioneuroablation for reflex syncope or functional bradycardia: Results from the cardionEuroabLation: patiEnt selection, imaGe integrAtioN and outComEs—The ELEGANCE multicenter study

医学 心动过缓 优雅 晕厥(音系) 内科学 心脏病学 反射 选择(遗传算法) 多中心研究 物理医学与康复 心率 血压 人工智能 美学 哲学 随机对照试验 计算机科学
作者
Pietro Francia,Daniel Viveros,Giulio Falasconi,Diego Penela,David Soto‐Iglesias,Julio Martí‐Almor,José Alderete,Andrea Saglietto,A Bellido,Paula Franco,Fátima Záraket,María Matiello,Juan Fernández‐Armenta,Rodolfo San Antonio,Antonio Berruezo
出处
期刊:Heart Rhythm [Elsevier]
卷期号:20 (9): 1279-1286 被引量:11
标识
DOI:10.1016/j.hrthm.2023.06.007
摘要

Cardioneuroablation (CNA) is a novel treatment for reflex syncope. The effect of aging on CNA efficacy is not fully understood.The purpose of this study was to assess the impact of aging on candidacy and efficacy of CNA for treating vasovagal syncope (VVS), carotid sinus syndrome (CSS), and functional bradyarrhythmia.The ELEGANCE (cardionEuroabLation: patiEnt selection, imaGe integrAtioN and outComEs) multicenter study assessed CNA in patients with reflex syncope or severe functional bradyarrhythmia. Patients underwent pre-CNA Holter electrocardiography (ECG), head-up tilt testing (HUT), and electrophysiological study. CNA candidacy and efficacy was assessed in 14 young (18-40 years), 26 middle-aged (41-60 years), and 20 older (>60 years) patients.Sixty patients (37 men; mean age 51 ± 16 years) underwent CNA. The majority (80%) had VVS, 8% had CSS, and 12% had functional bradycardia/atrioventricular block. Pre-CNA Holter ECG, HUT, and electrophysiological findings did not differ across age groups. Acute CNA success was 93%, without differences between age groups (P = .42). Post-CNA HUT response was negative in 53%, vasodepressor in 38%, cardioinhibitory in 7%, and mixed in 2%, without differences across age groups (P = .59). At follow-up (8 months, interquartile range 4-15), 53 patients (88%) were free of symptoms. Kaplan-Meier curves did not show differences in event-free survival between age groups (P = .29). The negative predictive value of a negative HUT was 91.7%.CNA is a viable treatment for reflex syncope and functional bradyarrhythmia in all ages, and is highly effective in mixed VVS. HUT is a key step in postablation clinical assessment.
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