Cardiac deceleration capacity as an indicator for cardioneuroablation in patients with refractory vasovagal syncope

Tu, Bin; Wu, Lingmin; Hu, Feng; Fan, Siyang; Liu, Shangyu; Liu, Limin; Ding, Ligang; Zheng, Lihui; Yao, Yan

doi:10.1016/j.hrthm.2021.12.007

Cited by 17 publications

(16 citation statements)

References 28 publications

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“…The efficiency of this method suggests that one of the main factors responsible for VVS is an abnormally increased vagal tone. The study of deceleration capacity (which is an HRA index related to the vagal activity) strengthens this conclusion (Zheng et al, 2020;Tu et al, 2022). In the case of cardioinhibitory VVS, the patients after cardioneuroablation treatment had lower mean RR and significantly changed HRV parameters toward parasympathetic withdrawal (Piotrowski et al, 2022).…”

Section: Discussionmentioning

confidence: 79%

An assessment of heart rate and blood pressure asymmetry in the diagnosis of vasovagal syncope in females

Pawłowski

Zalewski²,

Newton³

et al. 2023

Front. Physiol.

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Introduction: Heart Rate Asymmetry (HRA) describes a phenomenon of differences between accelerations and decelerations in human heart rate. Methods used for HRA assessment can be further implemented in the evaluation of asymmetry in blood pressure variations (Blood Pressure Asymmetry—BPA).Methods: We have analyzed retrospectively the series of heartbeat intervals extracted from ECG and beat-to-beat blood pressure signals from 16 vasovagal patients (age: 32.1 ± 13.3; BMI: 21.6 ± 3.8; all female) and 19 healthy subjects (age: 34.6 ± 7.6; BMI: 22.1 ± 3.4; all female) who have undergone tilt test (70°). Asymmetry was evaluated with Poincaré plot-based methods for 5 min recordings from supine and tilt stages of the test. The analyzed biosignals were heart rate (RR), diastolic (dBP) and systolic Blood Pressure (sBP) and Pulse Pressure (PP). In the paper we explored the differences between healthy and vasovagal women.Results: The changes of HRA indicators between supine and tilt were observed only in the control group (Porta Index p = 0.026 and Guzik Index p = 0.005). No significant differences in beat-to-beat variability (i.e. spread of points across the line of identity in Poincaré plot—SD1) of dBP was noted between supine and tilt in the vasovagal group (p = 0.433 in comparison to p = 0.014 in healthy females). Moreover, in vasovagal patients the PP was significantly different (supine: 41.47; tilt: 39.27 mmHg) comparing to healthy subjects (supine: 35.87; tilt: 33.50 mmHg) in supine (p = 0.019) and in tilt (p = 0.014).Discussion: Analysis of HRA and BPA represents a promising method for the evaluation of cardiovascular response to orthostatic stressors, however currently it is difficult to determine a subject’s underlying health condition based only on these parameters.

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Section: Discussionmentioning

confidence: 79%

An assessment of heart rate and blood pressure asymmetry in the diagnosis of vasovagal syncope in females

Pawłowski

Zalewski²,

Newton³

et al. 2023

Front. Physiol.

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“…Cardiac autonomic modification by an interventional method with minimal invasion is a new treatment idea; most previous curative effective studies have focused on VVS patients ( Pachon et al, 2005 ; Pachon et al, 2011 ; Yao et al, 2012 ; Aksu et al, 2016 ; Debruyne et al, 2018 ; Hu et al, 2019 ; Aksu et al, 2020 ; Pachon et al, 2020 ; Aksu et al, 2021 ; Debruyne et al, 2021 ; Tu et al, 2022 ) and shown high efficacy and safety. GP ablation can restore the balance between sympathetic and parasympathetic components and change their effects on diverse physiological functions of the heart.…”

Section: New Treatment For Refractory Symptomatic Sinus Node Dysfunct...mentioning

confidence: 99%

“…Thus, the modulatory effect of CNA on the vagal nerves indicates CNA may also be effective in patients with functional SND. Previous studies involving patients with SND who underwent CNA comprised several mixed cohort studies that included patients with VVS, SND, or FAVB ( Table 1 ) ( Pachon et al, 2005 ; Pachon et al, 2011 ; Yao et al, 2012 ; Zhao et al, 2015 ; Aksu et al, 2016 ; Qin et al, 2017 ; Debruyne et al, 2018 ; Hu et al, 2019 ; Aksu et al, 2020 ; Pachon et al, 2020 ; Aksu et al, 2021 ; Debruyne et al, 2021 ; Tu et al, 2022 ). Application of CNA to overcome the deleterious effects of enhanced vagal tone in bradyarrhythmia-related cases was originally reported by Pachon et al ( Pachon et al, 2005 ).…”

Section: New Treatment For Refractory Symptomatic Sinus Node Dysfunct...mentioning

confidence: 99%

“… d Percentage of symptomatic in ( Chiou et al, 1997 ); symptom score in ( Yao et al, 2012 ); number of prodromal symptoms in ( Hu et al, 2019 ); percentage of patients with obvious or recurrent symptoms in ( Pachon et al, 2020 ); syncope burden in ( Tu et al, 2022 ) and ( Aksu et al, 2016 ). e Functional data refer to the common indicators for observing the heart rate in CNA-related studies (mean heart rate in ( Chiou et al, 1997 ; Yao et al, 2012 ; Hu et al, 2019 ; Pachon et al, 2020 ); P-P interval in ( Tu et al, 2022 ) and ( Aksu et al, 2016 ). f Total corrected sinus node recovery time in the mixed-case cohort.…”

Section: New Treatment For Refractory Symptomatic Sinus Node Dysfunct...mentioning

confidence: 99%

“…It can blunt the excessive vagal activation of the heart and thus eliminate or improve the pathological conditions related to high vagal tone ( Pachon et al, 2005 ). CNA has been used successfully in preliminary studies in refractory VVS patients, particularly in treating the cardioinhibitory type (significant decrease in heart rate during syncope, occasionally accompanied with paroxysmal abnormal rhythm such as sinus bradycardia, sinus arrest, and atrioventricular block), and may enable patients to avoid the complications and financial burdens of long-term cardiac pacing ( Pachon et al, 2005 ; Pachon et al, 2011 ; Yao et al, 2012 ; Aksu et al, 2016 ; Debruyne et al, 2018 ; Hu et al, 2019 ; Aksu et al, 2020 ; Pachon et al, 2020 ; Aksu et al, 2021 ; Debruyne et al, 2021 ; Tu et al, 2022 ).…”

Section: Introductionmentioning

confidence: 99%

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Selection of patients with symptomatic vagal-induced sinus node dysfunction: Who will be the best candidate for cardioneuroablation?

2023

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Sinus node dysfunction is a multifaceted disorder with variable manifestations, the prevalence of which increases with age. In a specific group of patients, excessive vagal activity may be the sole cause for this condition. These patients are characterized as having recurrent daytime symptoms attributed to bradyarrhythmia, no evidence of organic sinus node lesions, cardiac vagal overactivation, and are non-elderly. For sinus node dysfunction patients, a permanent pacemaker implantation appears to be the ultimate solution, although it is not an etiological treatment. Cardioneuroablation is a promising emerging therapy that can fundamentally eliminate symptoms in a highly selective sub-set of sinus node dysfunction patients by cardiac vagal nerve denervation. Denervation with ablation for vagal-induced sinus node dysfunction can effectively improve sinus bradycardia and reduce syncope. To date, guidelines for selection of suitable candidates for cardioneuroablation remain lacking. The primary objective of this study was to distinguish the nature of abnormal sinus node function and to find methods for quantifying vagal tone. Clear selection criteria could help physicians in identification of patients with autonomic imbalance, thereby maximizing patient benefits and the success rate of cardioneuroablations.

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Characteristics of deceleration capacity and deceleration runs in vasovagal syncope

Li,

Sun,

Yang

et al. 2023

Clin Auton Res

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Cardiac deceleration capacity as an indicator for cardioneuroablation in patients with refractory vasovagal syncope

Cited by 17 publications

References 28 publications

An assessment of heart rate and blood pressure asymmetry in the diagnosis of vasovagal syncope in females

An assessment of heart rate and blood pressure asymmetry in the diagnosis of vasovagal syncope in females

Selection of patients with symptomatic vagal-induced sinus node dysfunction: Who will be the best candidate for cardioneuroablation?

Characteristics of deceleration capacity and deceleration runs in vasovagal syncope

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