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Clinical controversy : methodology and indications of cardioneuroablation for reflex syncope

Brignole, Michele (författare)
San Luca Hospital
Aksu, Tolga (författare)
Yeditepe University Hospital
Calò, Leonardo (författare)
Ospedale Policlinico Casilino - Roma
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Debruyne, Philippe (författare)
Imelda Hospital
Deharo, Jean Claude (författare)
Aix-Marseille University
Fanciulli, Alessandra (författare)
Medical University of Innsbruck
Fedorowski, Artur (författare)
Karolinska Institutet,Karolinska Institute,Lund University,Lunds universitet,Kardiovaskulär forskning - hypertoni,Forskargrupper vid Lunds universitet,Cardiovascular Research - Hypertension,Lund University Research Groups,Karolinska University Hospital
Kulakowski, Piotr (författare)
Grochowski Hospital
Morillo, Carlos (författare)
University of Calgary
Moya, Angel (författare)
University Hospital Dexeus
Olshansky, Brian (författare)
University of Iowa Hospitals
Piotrowski, Roman (författare)
Grochowski Hospital
Stec, Sebastian (författare)
Wichterle, Dan (författare)
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 (creator_code:org_t)
2023
2023
Engelska.
Ingår i: Europace : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology. - 1532-2092. ; 25:5, s. 1-10
Relaterad länk:
http://dx.doi.org/10... (free)
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https://lup.lub.lu.s...
https://doi.org/10.1...
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  • Tidskriftsartikel (refereegranskat)
Abstract Ämnesord
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  • In 2005, Pachon et al.1 proposed cardiac vagal denervation to treat neurally mediated syncope. Since then, a metanalysis of observational studies2 and a recent randomized controlled trial (RCT)3 have provided some evidence that cardioneuroablation (CNA) is able to prevent syncope recurrence at least during the first 2 years following the procedure in patients affected by reflex syncope. In brief, the recent metanalysis2 of 14 studies including a total of 465 patients reported an average freedom of syncopal recurrence in 92% of patients (95% confidence interval 88–95%) during follow-up. The only available open RCT3 reported 8% recurrence of syncope in the 24 patients randomized to CNA and 54% recurrence rate in 24 untreated controls (P = 0.0004) during 2-year follow-up. In all studies, after the ablation procedure, the patients demonstrated heart rate increase together with reduction of heart rate variability (indicating impaired parasympathetic stimulation of the heart) persisting at least for 2 years. This provides proof-of-concept for the modification of the vagal ganglia activity in the heart.Given these facts, it is likely that CNA will become increasingly popular among physicians caring for syncope patients in the years to come. Nevertheless, many issues concerning clinical indications, methodology, and long-term results remain unresolved. These issues constitute the background of this manuscript in which leaders in CNA and experts in syncope debated critical issues and aimed to find agreement and, if not possible, to highlight the controversies that could be addressed in future studies. The authors were initially requested to give their evidence-based opinion on several predefined motions. These were merged into a manuscript draft, which was subsequently critically revised by means of two rounds of comments.

Ämnesord

MEDICIN OCH HÄLSOVETENSKAP  -- Klinisk medicin -- Kardiologi (hsv//swe)
MEDICAL AND HEALTH SCIENCES  -- Clinical Medicine -- Cardiac and Cardiovascular Systems (hsv//eng)

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