Catheter Ablation of Atrioventricular Block

Abstract

A 39-year-old man presented with recurrent syncope. A 12-lead electrocardiogram and a 24-h Holter recording demonstrated atypical persistent Mobitz type I and high-degree atrioventricular block, respectively. The functional nature of the atrioventricular block was confirmed by atropine challenge, exercise testing, and electrophysiological study. The patient was successfully treated with a cardioneuroablation procedure. ( Level of Difficulty: Intermediate. )

Cardioneuroablation for Treatment of Atrioventricular Block

“…3 A few case reports, including from our group, have suggested that vagal overactivity may be contributary even in some patients with persistent AVB. 4–6 However, determination of the underlying mechanism of AVB is usually difficult, and the overwhelming majority of patients end up receiving permanent pacing. 1–3 Observational studies have shown that catheter ablation of ganglionated plexus (GPs) or cardioneuroablation can have salutary effects in some patients with vasovagal syncope (VVS) and sinus node dysfunction.…”

Improvement in Atrioventricular Conduction Using Cardioneuroablation Performed Immediately after Pulmonary Vein Isolation

“…The presented case describes an example of CNA utilization in patients with AF undergoing PVI who have concomitant problems with AV conduction. It shows that CNA can be useful not only in young but sometimes also in older patients with functional paroxysmal or persistent AV block [5][6][7]. In such patients, additional ablation at the area of inferior GPs, which are responsible for the autonomic control of AV conduction, may be effective.…”

“…The RF current affects GP and subsequently reduces vagal tone due to the prevalence of parasympathetic fibers within GP. This technique has been recently introduced into clinical practice to treat reflex syncope due to functional sinus arrest or AV block [5][6][7][8]. The two-year efficacy of CNA ranges between 80 and 90% in patients with syncope.…”

Reevaluation of the indications for permanent pacemaker implantation after cardioneuroablation

“…Cardioneuroablation (CNA) was shown to effectively treat functional bradycardia without the need for permanent pacemaker (PPM) implantation in a wide spectrum of bradyarrhythmias including sinus node dysfunction (SND), tachycardia-bradycardia syndrome, atrioventricular blocks (AVBs), cardioinhibitory or mixed vasovagal syncope (VVS), and cardioinhibitory carotid sinus syndrome or hypersensitivity. Pacemaker implantation is associated with costs, complications, and restrictions on daily activities [1][2][3][4]. However, although CNA is associated with a favorable risk-to-benefit ratio, low complication rates, and targeted modulation of cardiac autonomic innervation, currently, it is not recommended by guidelines [5,6].…”