Our center recently completed the first hospital-wide case of syncope treated with radiofrequency ablation of the cardiac vagal ganglion. Brief medical history The patient was a 22-year-old young female who had syncope 3 years ago, 2 years ago, and 1 week ago while walking, with blackness, weakness, cold sweating, no convulsions, and no diaphoresis before the attack. There was one episode of syncope at the time of admission and the nature of syncope was the same as before. At this time, the electrocardiogram suggested sinus arrest and junctional escape rhythm. The diagnosis was perfected with upright tilt test suggesting: positive, mixed diagnosis of vasovagal syncope. Treatment Puncture the interatrial septum for ablation of the left atrial vagal ganglion. Repeated 50ms ablation of multiple stimulation sites in the large head left atrium showed no vagal response, all inducing short bursts of atrial fibrillation. The ablation was then performed with anatomical localization of ganglion imaging. Vagal ganglion localization ablation targets: top of left upper pulmonary vein, anterior wall of left upper pulmonary vein vestibule, anterior and posterior wall of right pulmonary vein below left lower pulmonary vein and below right lower pulmonary vein Post-treatment effect Post-operative 1 month recheck tilt test was mixed before surgery and vasopressor type after surgery, suggesting improvement of cardiac suppression. Ding Chunhua, Cardiac Arrhythmia Treatment Center, Guangdong Provincial Hospital of Traditional Chinese Medicine
Study of small background vagal ganglion ablation for syncope
In 2011, Pachon JC published an article on endocardial parasympathetic ganglion ablation for neurally mediated syncope in Europace, which included 43 patients with vasovagal syncope who underwent radiofrequency ablation of the vagal ganglion, and found that the atrial endocardial myocardial potential was divided into 2 types by spectral analysis: compact myocardium (high amplitude, isotropic conduction The fibrillar myocardium (FM) was the target of ablation. After ablation of the FM, ablation of the fat pad of the epicardium was continued in endocardial dissection. between the aorta and superior chamber, between the right pulmonary vein and right atrium, and the posterior inferior septum.
Postoperatively, 3/43 cases developed neurally mediated syncope possibly related to syncope, of which 2 cases were positive and 1 was negative for the self-standing tilt test. However, it is interesting to note that the type of upright tilt test was changed in all these patients compared to the preoperative period, and cardiac depression was almost completely absent.
In 2012, our scholar published a study on left atrial vagal ganglion ablation for syncope in Circ Arrhythm Electrophysiol, which again confirmed the above-mentioned efficacy. At a follow-up of 30 ± 16 months, none of the 10 patients included had recurrent syncope, but 5/10 had prodromal symptoms. The upright tilt test was repeated postoperatively and was positive in 4/10 cases, but the onset of syncope was delayed compared to the preoperative period.
The above study, although with a small sample size, indicates that radiofrequency ablation of the vagal ganglion is an important exploration in syncope treatment strategy. The success of ablation in our center adds to the clinical practice of this method.
Reference.
Pachon JC, Pachon EI, Cunha Pachon MZ, Lobo TJ, Pachon JC, Santillana TG. Catheter ablation of severe neurally meditated reflex (neurocardiogenic or vasovagal) syncope: cardioneuroablation long-term results. Europace. 2011. Sep;13(9):1231-42.
Yao Y, Shi R, Wong T, Zheng L, Chen W, Yang L, Huang W, Bao J, Zhang S. Endocardial autonomic denervation of the left atrium to treat vasovagal syncope: an early experience in humans. Circ Arrhythm Electrophysiol. 2012 Apr;5(2):279-86.
The Arrhythmia Center of Guangdong Provincial Hospital of Traditional Chinese Medicine is located in the beautiful environment of Guangzhou University City. Founded and led by Director Ding Chunhua, who returned from the University of California Heart Center, the Center specializes in minimally invasive procedures such as radiofrequency ablation and pacemaker implantation for arrhythmia-related diseases (rapid or slow heartbeat, irregular heartbeat, premature beats, intervals, heart failure and syncope), combined with special Chinese medicine treatment and research.
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Chunhua Ding, male, is a returned expert from University of California Heart Center in San Francisco, USA, doctoral supervisor and researcher in Cardiovascular Medicine. He is the Director of Cardiac Arrhythmia Center of Guangdong Provincial Hospital of Traditional Chinese Medicine, and the Director of Cardiac Electrophysiology Research Unit of Guangdong Academy of Traditional Chinese Medicine.
He is an editorial board member of Heart Rhythm, an international authoritative journal of cardiac arrhythmia, a member of the American Heart Rhythm Association, an executive vice chairman of the Cardiac Arrhythmia Committee of the Guangdong Association of Integrative Medicine, a member of the Standing Committee of the Cardiac Pacing and Electrophysiology Branch of the Guangdong Medical Association, a member of the Cardiac Rhythmology Committee of the Chinese Medical Association, and a member of the Cardiac Technology Training Expert Committee.
Specialties: catheter radiofrequency ablation, pacemaker, implantable cardioverter-defibrillator (ICD) surgery, combined Chinese and Western medicine diagnosis and treatment of cardiac arrhythmias (rapid or slow heartbeat, arrhythmia, premature beats, intervals, including pre-excitation syndrome, supraventricular tachycardia, ventricular tachycardia, atrial tachycardia, atrial flutter, atrial fibrillation, atrial premature, ventricular premature, bradycardia), heart failure and syncope (dizziness, fainting).
Consultation time: Monday afternoon (University City Hospital), Wednesday morning (Dade Road General Hospital)
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Huang Guibao: Attending physician, master of cardiovascular specialty. He is a member of the Cardiac Arrhythmia Committee, the Brain and Heart Treatment Committee and the Heart Failure Committee of the Guangdong Association of Integrative Medicine, and a member of the Internal Medicine Committee of the Guangdong Association of Traditional Chinese Medicine. He inherited the academic thought of treating heart disease from Professor Deng Tietao, a national medical master, and is good at regulating the spleen and protecting the heart.
Specialties: pacemaker implantation, combined Chinese and Western medicine treatment of arrhythmia, heart failure, syncope, dizziness.
Consultation time: Monday morning (Dade Road General Hospital)
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Zhang Wenchang [Chang3]: Attending physician, Master of Cardiovascular. He is a member of the Guangdong Medical Doctor’s Association Cardiac Pacing and Electrophysiology Physician Branch, a member and secretary of the Guangdong Association of Integrated Chinese and Western Medicine Arrhythmia Committee, and a member of the Heart Failure Committee.
Specialties: catheter radiofrequency ablation, pacemaker implantation, combined Chinese and Western medicine treatment of arrhythmia, heart failure, dizziness or syncope.
Visiting hours: Friday afternoon (University City Hospital)
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Huang Shen: Attending physician, Master of Cardiovascular Medicine, graduated from Tongji Medical College of Huazhong University of Science and Technology. He is a member of the Cardiac Arrhythmia Committee and Heart Failure Committee of the Guangdong Association of Integrative Medicine.
Specialties: radiofrequency ablation and drug treatment of arrhythmia, drug and device treatment of bradycardia and heart failure.
Visiting hours:Wednesday afternoon (University City Hospital)