CNA Conference - Dr. Alexander Alvarez Ortiz - Effectiveness of Cardioneuroablation in Neurocardiogenic Syncope: Prospective Cohort - Experience of a Pioneer Center in Colombia

Our next presentation will be by Doctor Alexander Alvarez Ortiz. Um, Dr. Alvarez Ortiz is the chief electrophysiologist at the uh Heart Institute of Bocaramanga in Colombia. And he'll be talking to us about the effectiveness of cardio ablation in neurocardiogenic syncope, a prospective cohort experience of a pioneer, of a pioneer center in Colombia. Telling day for everyone. Thanks for the organization of the 2nd World Congress on cardio regulation. In this moment we are going to present the next study called cardio ablation in the management of neurocardio synco with extra cardiac validation, efficacy and effects on the regulation of the cardiac autonomic system and a respective core study in Colombia. Researchers Alexander Alvarez Ortiz, Leonard Rugenia Marino Murillo, Carlos Tenne Paon, and Jose Carlos Pachon Mateos. Neurocardiogenic syncope. is a transient loss of consciousness due to global cerebral hypoperfusion. It is a frequent cause of admission to the emergency department and intensive care unit 36 with a high annual recurrence rate of up to 50% and deterioration in quality of life. Non-pharmacological treatment and hydration. are the basis of management. And some patients may require medication or pacemaker implantation with variable clinical response and often with a high recurrence rate based on the pathophysiological and anatomical structural mechanisms of the sympathetic and parasympathetic systems. Invasive procedures in the area of cardiovascular electrophysiology called cardio neuroablation, and they are being performed with very promising and sustainable results. Current expert recommendation for Sienna. At this time, cardio and neuroablation are indicated for patients with refractory and recurrent vasovagal syncope. Despite non-pharmacological. And conservative management. It is indicated in patients with documented as assist told by event monitor or documented as assisted by tilt table test with a cardio inhibitory component at an age younger than 40 years. Cardio or neuroablation is recommended in such cases. In patients older than 40 years. Cario neuroablation may be considered as first line therapy for mixed neurocardiogenic syncope, refractory to treatment with midodrine or cortisoneal fluid and remaining symptomatic. Cart neuroablation may be considered for the recurrence of syncoptology type of study. Observational analytical study of a respective goldor approved by the Ethics and Research Committee of the Bukarmaga Heart Institute. Retrospective component from September 1, 2071 to March 1981, 2023. Prospective component from April 1, 2023 to September 30, 2023. Objective is. General objective to determine the recurrence of the first episode of syncope and the quality of life of patients with neurocardiogenic syncope refractory to conventional management who underwent a cardio neuroablation procedure in a fourth-level care institution in Colombia. Specific objectives to describe the clinical and socio-demographic characteristics. Of patients with neurocardiogenic syncope refractory to conventional management who underwent cardio neuroablation procedures in a fourth-level care institution in Colombia. To describe the clinical and socio-demographic characteristics of patients with neurocardiogenic syncorefractory to conventional management who underwent cardio neuroablation procedures in 1/4 level care institution in Colombia. To evaluate the recurrence of the first episode of neurocardiogenic syncope after cardio neoablation. To compare the incidents. Of neurocardiogenic syncope recurrence in both the cardio inhibitory and mixing groups. To determine the quality of life in patients with neurocardiogenic syncope after cardio ablation. To evaluate the autonomic component in cardiac holter. Heart rate variability in patients with neurocardiogenic syncope after cardio neuroablation. Outcomes primary outcome. Presents of the first episode of syncope following cardio neuroablation. Secondary outcomes, change in heart rate variability in terms of time domain following cardio neuroablation, change in postcardio neuroablation quality of life skills. Met inclusion criteria neurocardiogenic syncope. Refractory to conventional management in mixed cardio inhibitory to IN 2 build conventional treatment for neurocardiogenic syncope, non-pharmacological, pharmacological, cardiobilitation therapy, counterpulsation measures, etc. for at least 6 months. Positive atropine test. Prior to cardio neo ablation procedure, for at least 3 days, increase in heart rate greater than 50% of baseline heart rate, electroencephalogram and brain imaging study without lesions, the patients underwent cardio ablation of the ganglionic plexus with conventional electroatomic mapping technique. Radio frequency ablation and validation with extracranial neurostimulation, exclusion. Criteria presence of pathology or history of neoplasia or chronic disease with life expectancy of less than one year. Incomplete information, hospitalization, mortality, and cardiovascular tests required for outcome assessment. Informed consent form was signed follow-up protocol established prior to the procedure. Pre and postcardine ablation syncopal episode 24 hour. Blood pressure monitoring prior to and every 3 months after cardio neuroablation tilt table test, 3 to 6 months postcardial neuroablation follow up every 3 months, quality of life assessment from S36 before and after cardio neuroablation. Data were independently duplicated and validated, entered into human expression statistics. 28.000.0 software, some precise selection of research subjects, universe of the study population. The sample size calculation was conducted with an alpha level of 0.5 and desired statical power 1 of 0.90. The estimated hazard ratio was set at 0.23, which was derived from a study by ASCU as a result of these calculations. The minimum number of events required for the study was then the estimated sample size required for the study was found to be 41 patients. The results of 45 patients will be presented statistical. Analysis univariate analysis results are presented as mean SDR numbers and percentages for normally distributed data and median and range for non-normally distributed data. The XG electrophysiological, the quality of life and how V values obtained before and after CNI were compared using student TES test. We calculate the incidence of neurocardiogenic syncope recurrence in the sto population and the univariate Cook's proportional hazard regression to estimate the unadjusted hazard ratio or neurocardiogenic syncope recurrence. B variate analysis, Kaplan Mayer method. Exposure Very valuables in coupe subtype perform viva costs. We calculate the proportion of hazardous regression to estimate adjusted hazard ratios. We calculate the incidence of neurocardiogenic syncopic currents in both the CIO inhibitory and mixed syncopic groups for cardio inhibitory syncope compared to mixed syncope. Ethical consideration, the study was conducted in accordance with the principles outlined in the Declaration of Helsinki. According to Resolution 8430 chapter 1, Article 11 of 1993 of the Colombian Ministry of Health in relation to research on living subjects, the present studies classified within the category of research without risk. The principle of confidentiality was maintained according. To the statutory law 1581 of 2012. Principle of legality in data processing, principle of purpose, principle of freedom, principle of truthfulness or equality, principle of transparency. Chemical and socio-demographic variables. It was found that the average age was 43.4 years with a 71 female population. Regarding tilt table test results, 73.3 had cardio inhibitory type and 26.7 had mixed type. The quality of life scores 46 before was 81.91. As a medical historian, comorbidities, 28.9. Who population hypertension 2015.6% for diabetic and in patients 20 cars to atrial fibrillation and one patient had a history of smoking. Additionally, 2.2 had a history of cerebrovascular disease, 35.6% of the population had a history of pacemaker implantation, and one patient had a cardiac DC. About 51 patients were receiving miiodine 8.9 cortisone that fluid. 32.3 antidepressants and more than half of the patients were on beta blockers. Additionally, 11.1, we're taking a big 7 11.1 mida. And 11.1 on propafenon. Regarding chochocardiography, the uh ejecting fracture was 62.98. The left atrial posterior diameter and left atrial were within normal limits, and 40% of the population had a normal electrocardiogram. Bradycardias in radium was present in 44.4 in patient. 5 patients have pulses, wait around 3 seconds. 1 patient a atrial fibrillation. And one patient a second to get out and prela block. The average already before cardio neural ablation was CM 1.3 cm beats per minute. The average ystolic blood pressure was 29.70 3. And the pressure was 75.2. Yeah, maximum was 440 milliseconds parameters with 438.178 and has an index of 79.33 instead of 38.77 and ptos 11.4 424. Regarding the procedure, the average total procedure time was 114.67 minutes with a few oroscopy of 1.5 or so minutes. Cardi node ablation was performed in a single atrium for 77.8% of patients and in both atria for 22.2 patients. Lions were applied to ganglion plexus is as follows, 3 0.2 in the right anterior, honar plexus, 8.8 in the right atrium, 6.9 in the inferior right ganglion plexus, and 7 in the left superior ganglion plexus. Laing procedure related complications. 3 patients had vascular injuries. 1 patient had pericardial effusion that did not require drainage. 1 patient developed superficial peripheral neuropathy with normal electromyography exams, and 1 patient had deep vein thrombosis that resulted after to undergo regulation therapy. Uh, and for ouristolic blood pressure before and after cardio, you know, in prison, there were no statistically significant differences at 6 and 12 months. Similarly, there were no statistically significant differences in diastolic blood pressure. Before cardio ablation and after cardio ablation, there was no statistically significant difference. In terms of heart rate and cardion ablation, the average heart rate increased from 61 to 80 beats per minute after the procedure, showing statistically significant differences. Regarding quality of life, there were statistically significant differences in after cardio ablation with an SL 36 score of 81.91 before the procedure and 93.0 afterwards. Regarding heart rate variability and caring or ablation, and statistically significant reduction in stent was found before. And after the procedure with a value of 138.170 milliseconds per cardional regulation and 5000, 372.72 milliseconds postcional regulation with a statistically significant P value. In the sun index, uh, statistically significant reduction was observed before and after carrionovulation from 79.53 to 4,639.44 respectively with a statistically significant P-value. Well, thank you, Doctor Alvarez Ortiz. He is not able to join us for Q&A. So we're gonna keep moving on with the program.