Electroanatomic-mapping-guided cardioneuroablation versus combined approach for vasovagal syncope: a cross-sectional observational study

Abstract

This pilot study shows that EAM-guided CNA strategy is feasible and safe in VVS patients resistant to conventional therapies.

Why is pulmonary vein isolation not enough for vagal denervation in all cases?

“…Since 2005, ablation of GPs has been attempted to attenuate vagal activity on the sinus and atrioventricular nodes and many reports confirmed the applicability of cardioneuroablation in different clinical settings consisting of refractory vasovagal syncope, functional sinus bradycardia, and functional atrioventricular block 5‐9 . Great majority of GPs are concentrated within distinct epicardial fat pads between right and left atrial structures.…”

“…All pulmonary veins remained isolated. GP sites were detected by using our previously defined fractionated electrograms (EGMs)‐based technique during sinus rhythm 5 . Briefly, three‐dimensional electroanatomic maps of both atria were created using EnSite Precision Cardiac Mapping System (EnSite Velocity, Abbott, Sylmar, CA, USA) and bipolar endocardial atrial EGMs were evaluated for amplitude and number of deflections at filter settings of 200‐500 Hz and a sweep speed of 200‐400 mm/s.…”

Long-term Efficacy and Safety of Cardioneuroablation in Patients with Vagally Mediated Bradyarrhythmias

“…In our previous strategy (before 7 th of December 2015), GPs were detected by using a combination of fast Fourier transform analysis, HFS and empirical anatomic ablation (7) . Anatomical shell of the left atrium (LA) and the right atrium (RA) was created by using EnSite Velocity system (Abbott, Sylmar, CA, USA).…”

Response to the letter concerning the article: “Cardioneuroablation using an anatomical approach: a new and promising method for the treatment of cardioinhibitory neurocardiogenic syncope”

“…Indeed, the optimal procedural strategy and endpoints of cardioneuroablation (CNA) in patients with neural reflex syncope have not yet been established. The new methods described by Aksu et al [2] in their letter are very interesting and hopefully will improve the outcome after CNA. In our recent cases we used high-frequency stimulation of the carotid sinus via a catheter introduced into the internal jugular vein and also observed a spectacular disappearance of vagal reflexes causing asystole following CNA.…”