目的 探讨左心房心内膜迷走神经结射频消融术治疗青年血管迷走性晕厥的可行性。方法 纳入解放军联勤保障部队第903医院收治的难治性血管迷走性晕厥青年患者18例，均为男性，年龄(21.0±1.9)岁，均对常规治疗无效。18例患者均采用三维标测系统重建左心房模型，于左心房的6个自主神经节(GP)解剖分布区域行左心房心内膜去神经化射频消融治疗，观察消融术中出现血压下降、窦性心动过缓或窦性停搏、交界性逸搏等迷走反应情况，消融终点为迷走反应消失。术后定期随访，记录晕厥、晕厥前兆的发生情况并复查动态心电图和直立倾斜试验。结果 17例患者在消融中诱发出迷走反应，并达到消融终点，1例患者未能诱发出明显的迷走反应。随访(13±3)个月，17例患者未发生晕厥，1例患者术后仍有黑朦及晕厥发生，但较术前发生晕厥的频率明显减少，自觉症状明显改善。所有患者均无手术相关并发症发生。结论 左心房心内膜去神经化射频消融治疗难治性血管迷走性晕厥安全、有效，并能预防复发。

Objective To explore the feasibility of radiofrequency ablation of the left atrial endocardial vagus nerve junction for the treatment of refractory vasovagal syncope(VVS) in young patients.Methods A total of 18 patients with refractory VVS,who were admitted to the No.903 Hospital of Joint Logistics Support Force of the Chinese People′s Liberation Army, were enrolled in this study.All patients were male, with a mean age of(21.0±1.9) years, and conventional treatment was ineffective.In all the 18 patients, a three-dimensional mapping system was used to reconstruct the left atrial model, and left atrial endocardial denervation radiofrequency ablation was performed in the anatomical distribution areas of the six ganglionated plexi(GP) in the left atrium.The left atrial endocardial denervation radiofrequency ablation was performed, the occurrences of vagal reactions such as blood pressure drop, sinus bradycardia or sinus arrest, junctional escape, etc.during ablation procedure were recorded, and the endpoint of ablation was the disappearance of vagal reactions.After surgery, the patients were regularly followed up, the occurrence of fainting and its precursors was recorded, and reexamination of the dynamic electrocardiogram and upright tilt test was performed.Results During radiofrequency ablation, 17 patients developed vagal reactions and reached the endpoint of ablation, and obvious vagal reaction failed to be induced in one patient.During the follow-up period of(13±3) months, no syncope occurred in 17 patients, and one patient still had amaurosis and syncope after surgery, but the frequency of syncope was significantly reduced compared to his preoperative situation, and the subjective symptoms were improved significantly.No surgery-related complications occurred in all patients.Conclusion For the treatment of refractory VVS in young patients, the left atrial endocardial denervation with radiofrequency ablation is clinically safe and effective, and it can also effectively prevent VVS recurrence.