Differential effect of ganglionic plexi ablation in a patient with neurally mediated syncope and intermittent atrioventricular block

Fukunaga, Masato; Wichterle, Dan; Peichl, Petr; Aldhoon, Bashar; Čihák, Robert; Kautzner, Josef

doi:10.1093/europace/euw100

Cited by 26 publications

(29 citation statements)

References 20 publications

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“…Endocardial GP ablation has been increasingly used to treat severe vagal-related arrhythmias. [8][9][10][11][12][13][14] Although the guidelines 20 indicate pacemaker implantation for cases of symptomatic bradycardia and atrioventricular block, the fact that these patients are mostly young and otherwise healthy individuals encourages a more conservative approach.…”

Section: Discussionmentioning

confidence: 99%

“…The diverse GP-mapping strategies used by different authors (1, high-frequency endocardial stimulation [2][3][4][5][6][8][9][10][11][12] ; 2, purely anatomic location 7,13 ; and 3, atrial electrogram characteristics 1,10,14,15 ) emerged as potential alternatives, with each one proposing specific end points (1, evoked reflex abolition; 2, ablation of all anatomic GP sites achieved; and 3, elimination of all fragmented potentials, respectively). However, some important questions still remain whichever technique is chosen:…”

Section: See Editorial By Mulpuru and Shenmentioning

confidence: 99%

“…Ganglionated plexus (GP) ablation for the treatment of vagal-related atrial fibrillation [1][2][3][4][5][6][7] and symptomatic bradycardia, [8][9][10][11][12][13][14] such as cardioinhibitory vasovagal syncope, has been widely studied, and although convincing results had been reported by some authors, no consensus still exists on the most adequate technique to identify the critical targets or end points indicating clinical vagal attenuation.…”

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confidence: 99%

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Targets and End Points in Cardiac Autonomic Denervation Procedures

Rivarola

Hachul

et al. 2017

Circ: Arrhythmia and Electrophysiology

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Background-Autonomic denervation is an alternative approach for patients with symptomatic bradycardia. No consensus exists on the critical targets and end points of the procedure. The aim of this study was to identify immediate end points and critical atrial regions responsible for vagal denervation. Methods and Results-We enrolled 14 patients (50% men; age: 34.0±13.8 years) with cardioinhibitory syncope, advanced atrioventricular block or sinus arrest, and no structural heart disease. Anatomic mapping of ganglionated plexuses was performed, followed by radiofrequency ablation. Heart rate, sinus node recovery time, Wenckebach cycle length, and atrial-His (AH) interval were measured before and after every radiofrequency pulse. Wilcoxon signed-rank test was used for comparison. Significant shortening of the R-R interval (P=0.0009), Wenckebach cycle length (P=0.0009), and AH intervals (P=0.0014) was observed after ablation. The heart rate elevation was 23.8±12.5%, and the Wenckebach cycle length and AH interval shortening was 18.1±11% and 24.6±19%, respectively. Atropine bolus injection (0.04 mg/kg) did not increase heart rate further. Targeting a single spot of the left side (64% of the patients) or right side (36%) of the interatrial septum was observed to be responsible for ≥80% of the final R-R and AH interval shortening during ablation. Conclusions-Targeting specific sites of the interatrial septum is followed by an increase in heart rate and atrioventricular nodal conduction properties and might be critical for vagal attenuation. The R-R interval, Wenckebach cycle length, and AH interval shortening, associated with a negative response to atropine, could be considered immediate end points of the procedure.

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Section: Discussionmentioning

confidence: 99%

Section: See Editorial By Mulpuru and Shenmentioning

confidence: 99%

mentioning

confidence: 99%

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Targets and End Points in Cardiac Autonomic Denervation Procedures

Rivarola

Hachul

et al. 2017

Circ: Arrhythmia and Electrophysiology

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“…The properties of the atrial wall and may be identified by changes in the spectrum as "AF Nests" [22][23][24][25] (this name resulted from its relation with the AF physiopathology as they present electrical resonance 26,27 favoring the AF maintenance).…”

Section: Rf Catheter Ablation For Vagal Denervationmentioning

confidence: 99%

Cardioneuroablation: Catheter Vagal Denervation as a New Therapy for Cardioinhibitory Syncope

Mateos

Higuti

et al. 2020

J Cardiac Arrhtythmias

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The vasovagal syncope is the most frequent cause of transient loss of consciousness, especially in young people without significant heart disease. The malignant cardioinhibitory form is caused by abrupt and intense vagal reflex with or without defined triggers. Refractory cases to preventive measures and pharmacological handling has been treated with definitive pacemaker implantation. Besides showing questionable results, pacemaker implantation is highly rejected by young patients. In the late 1990s, we proposed specific vagal denervation by catheter ablation and spectral mapping, for paroxysmal AF, functional bradyarrhythmias and severe cases of malignant cardioinhibitory syncope giving rise to cardioneuroablation. Recently, many authors worldwide have been reproducing the cardioneuroablation results where elimination or significant reduction of the vagal response were observed, which abolished symptoms in more than 75% of patients followed up to 14 years, without complications. Therefore, cardioneuroablation has shown to be a real therapeutic option in malignant syncope cardioinhibitory and in any exclusive vagal mediated bradyarrhythmia without the need for pacemaker implantation.

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“…). Essa mistura de células altera algumas propriedades elétricas da parede atrial e pode ser identificada por alterações no espectro como "ninhos de FA"[22][23][24][25] (esse nome é resultado da sua relação com a fisiopatologia da FA, pois apresentam ressonância elétrica26,27 . O terceiro neurônio está localizado no centro nervoso no núcleo dorsal do nervo vago, nos núcleos solitário e ambíguo.…”

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Cardioneuroablação: A Denervação Vagal por Cateter Como Nova Terapia para Síncope Cardioinibitória

Mateos

Higuti

et al. 2020

J Cardiac Arrhtythmias

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A síncope vasovagal é a causa mais frequente de perda transitória de consciência, especialmente em jovens sem doença cardíaca significativa. A forma cardioinibitória maligna é causada por reflexo vagal abrupto e intenso com ou sem gatilhos definidos. Casos refratários a medidas preventivas e manuseio farmacológico foram tratados com implante definitivo de marcapasso. Além de apresentar resultados questionáveis, o implante de marcapasso é altamente rejeitado por pacientes jovens. No final dos anos 1990, propusemos uma denervação vagal específica por ablação do cateter e mapeamento espectral para FA paroxística, bradiarritmias funcionais e casos graves de síncope cardioinibitória maligna dando origem à cardioneuroablação. Recentemente, muitos autores em todo o mundo vêm reproduzindo os resultados da cardioneuroablação, onde se observou eliminação ou redução significativa da resposta vagal, o que aboliu sintomas em mais de 75% dos pacientes acompanhados por até 14 anos, sem complicações. Portanto a cardioneuroablação tem se mostrado uma verdadeira opção terapêutica na síncope cardioinibitória maligna e em qualquer bradiarritmia vagal exclusiva mediada sem a necessidade de implante de marcapasso.

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Differential effect of ganglionic plexi ablation in a patient with neurally mediated syncope and intermittent atrioventricular block

Cited by 26 publications

References 20 publications

Targets and End Points in Cardiac Autonomic Denervation Procedures

Targets and End Points in Cardiac Autonomic Denervation Procedures

Cardioneuroablation: Catheter Vagal Denervation as a New Therapy for Cardioinhibitory Syncope

Cardioneuroablação: A Denervação Vagal por Cateter Como Nova Terapia para Síncope Cardioinibitória

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