Clinical Study Of Modified Cardiac Autonomic Ganglion Plexus For Symptomatic Sinus Bradycardia

Research Background:Symptomatic bradycardia refers to sinus bradycardia with clinical symptoms.It is a common bradycardia,which is closely related to the imbalance of the autonomic nerve of the heart.In the past,the clinical treatment of symptomatic bradycardia was mainly based on drug and pacemaker implantation,but long-term drug treatment has relatively large side effects.For younger patients,after pacemaker implantation,they will also face the pacemaker battery running out and undergo surgery again,increasing the surgical pain and potential infection risk of patients.The improvement of cardiac autonomic ganglion is to ablation the 5 key autonomic ganglion plexus of the left and right atrium by catheter.Reduce the vagus tone of the heart,so as to increase the heart rate,reduce the symptoms of symptomatic bradycardia patients.Objective:The objective of this study was to determine the efficacy and safety of cardiac autonomic nerve modification for symptomatic bradycardia,and to compare the clinical efficacy of "unilateral" and "bilateral" cardiac autonomic ganglion ablation strategies for symptomatic bradycardia.Methods:In this study,patients with symptomatic bradycardia who received catheter ablation(modified cardiac autonomic ganglion)in Nanfang Hospital of Southern Medical University from June 2019 to December 2022 were retrospectively enrolled.After screening and exclusion of all patients,75 patients were finally enrolled,including 19 patients in the unilateral GP ablation group(only the right atrial GP ablation).Bilateral GP ablation group included 56 patients(left and right atrial bilateral GP ablation).Baseline data(including age,gender,BMI and other general information),test indicators,cardiac color doppler ultrasound parameters,ablation data,and followup data of all patients were collected.Preoperative and postoperative heart rate changes,symptom improvement,and safety during follow-up were evaluated in both groups.Results:At the end of ablation,the immediate heart rate in all patient groups was increased by 29.87±10.87 beats/min compared with the preoperative average heart rate,among which the immediate heart rate in the unilateral GP ablation group was increased by 26.26±10.19 beats/min compared with the preoperative average heart rate,and that in the bilateral GP ablation group was increased by 29.95±9.29 beats/min compared with the preoperative average heart rate.After a follow-up of 9.37±5.88 months,the mean heart rate in all patient groups increased by 17.05±9.30 beats/min compared with that before surgery.Comparison between the two groups:the follow-up time of unilateral GP ablation group was 8.79±3.14 months,and the average heart rate was increased by(11.00±7.04)times/min compared with that before surgery;the follow-up time of bilateral GP ablation group was 9.5 5±5.23 months,and the average heart rate was increased by 19.11 ±9.03 times/min compared with that before surgery,with statistical difference between the two groups(P=0.001).In the postoperative follow-up period,85.33%of patients had improved clinical symptoms,among which unilateral GP ablation group accounted for 84.21%and bilateral GP ablation group accounted for 85.71%.Except for one patient with postoperative local hematoma at the puncture site,there were no other surgery-related complications.Conclusions:Radiofrequency catheter ablation of the autonomic ganglia at five key locations of the left and right atria can safely and effectively improve the 24-hour average heart rate and clinical symptoms of symptomatic bradycardia patients without organic lesions of the sinus node,and the long-term effect of bilateral GP ablation is better than unilateral GP ablation in increasing heart rates.