Clinical Value Of Left Atrial Vagal Plexus Ablation In Patients With Vasovagal Syncope

Objective: Vasovagal syncope(VVS)is based on abnormally active parasympathetic innervation,with sudden collapse as the main manifestation.Patients often suffer irreversible consequences due to secondary injuries,which often leads to the loss of working ability and some life skills(such as driving,climbing,special life scenes,etc.).At present,there is a lack of effective treatment plan for patients with ineffective physical training.In this study,patients with VVS were treated by ablation of left atrial endocardial ganglia plexus to evaluate the therapeutic effect and the improvement of vagus nerve,(we evaluated the treatment effect and improvement of the vagus nerve by ablating the left atrial endocardial ganglion plexus in patients with VVS),so as to find a feasible and effective way for clinical treatment of this kind of diseases.Methods: By collecting 20 patients diagnosed as VVS from June 2019 to June 2021 in the Department of Cardiology,the 940 th Hospital of Joint Logistics Support Force of Chinese PLA.Exclude organic diseases and collect general clinical data of patients.All patients had no response to routine treatment,so they were performed to map and ablate the left atrial endocardial Ganglionated plexus(GP)under high frequency stimulation,HFS).To compare the changes in heart rate,sinus node recovery time,and atrioventricular conduction ventromedial point between pre-operative and intra-operative time.Follow-up visits were performed at 3 and 6 months after surgery to record the recurrence of syncope and syncope precursors of patients.The HUTT and Holter were repeated to dynamically observe the indicators of reflecting cardiac autonomic function.Results: 1.Twenty consecutive patients,including 16 males and 4 females,aged 15-28 years with an average of(23.60±7.14)years,had a history of syncope of 12.0(6.5,36.0)months and 3(3,5)times of syncop;2.All patients completed ganglionic plexus ablation,15 patients completed left superior ganglionated plexus(LSGP)and right anterior ganglionated plexus(RAGP)ablation and 5 patients underwent LSGP ablation;3.All patients were positive in preoperative HUTT,which showed vasopressive and mixed type.Fourteen patients had syncope precursors and three patients suffered syncope leading to trauma.After 3 months’ operation,4 cases were positive in HUTT.After 6 months’ operation,2 cases were positive in HUTT.During 6 months after operation,6 patients had syncope precursors,but no recurrence of syncope or physical injury;4.In the time-domain indexes of HRV,compared with before ablation,the time-domain indexes of HRV SDNN,SDNN,SDNNi,rMSSD and pNN50 at 3 months and 6 months after operation were all smaller than those before operation,and the difference was statistically significant(P<0.05).Compared with preoperative,there were statistically significant differences in SDNN,SDANN,SDNNi and pNN50 in 3 months after operation(P< 0.05).There were significant differences in SDNN,SDANN,SDNNi and rMSSD between 6 months after operation and before operation(P< 0.05).Compared with 3 months after ablation,there were significant differences in SDNN and SDANN 6 months after ablation(P<0.05);5.Before ablation,the DC value was6.66±2.08 ms,DR2 value was 8.37±1.75 ms,DR4 value was 0.58±0.24 ms,DR8 value was[0.00(0.00 ～ 0.01)](× 10-3)%,which were all lower than those before ablation,with no statistical significance(P >0.05)In each period,the count value from DR2 to DR8 decreased exponentially;6.According to the correlation analysis between DC and HRV in time domain before operation,DC was positively correlated with SDANN,SDNNi,rMSSD and pNN50,but negatively correlated with STANNN,with no correlation(P>0.05).At the 3 months after operation,DC was positively correlated with SDNN and SDNNi,while the remaining indexes were negatively correlated,with no correlation(P>0.05).At 6 months after operation,DC was positively correlated with HRV time domain indexes,among which SDNN and SDNNi were correlated(P<0.05).Conclusion: The results showed that ablation of left atrial endocardial ganglia plexus can obviously improve the symptoms of patients and prevent the recurrence of vasovagal syncope.The time-domain index of HRV and DC were lower than those before operation,suggesting that vagus nerve tension was weakened during ablation,especially parasympathetic nerve had been improved obviously.