Ganglionated plexi ablation in right atrium to treat cardioinhibitory neurocardiogenic syncope

Rebecchi, Marco; Ruvo, Ermenegildo De; Strano, Stefano; Sciarra, Luigi; Golia, Paolo; Martino, Annamaria; Calò, Leonardo

doi:10.1007/s10840-012-9666-5

Cited by 32 publications

(33 citation statements)

References 12 publications

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“…Liang et al performed an HFS‐guided atrial vagal ablation (near coronary sinus ostium and super vena cava and at the posterior wall of the pulmonary vein antrum) in a woman aged 57 years and achieved 12‐month survival without any syncope. Rebecchi et al presented an anatomically guided ablation of the supero‐, mid‐, and inferoposterior right atrium in 2 patients. Syncope recurred in 1 patient 5 months later and was absent in 1 patient during an 8‐month follow‐up period.…”

Section: Discussionmentioning

confidence: 99%

Catheter Ablation as a Treatment for Vasovagal Syncope: Long‐Term Outcome of Endocardial Autonomic Modification of the Left Atrium

Sun

Zheng

et al. 2016

JAHA

119

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BackgroundAutonomic modification through catheter ablation of ganglionated plexi (GPs) in the left atrium has been reported previously as a treatment for vasovagal syncope. This study aimed to observe the long‐term outcome in a larger cohort.Methods and ResultsA total of 57 consecutive patients (aged 43.2±13.4 years; 35 women) with refractory vasovagal syncope were enrolled, and high‐frequency stimulation and anatomically guided GP ablation were performed in 10 and 47 cases, respectively. A total of 127 GP sites with positive vagal response were successfully elicited and ablated, including 52 left superior, 19 left lateral, 18 left inferior, 27 right anterior, and 11 right inferior GPs. During follow‐up of 36.4±22.2 months (range 12–102 months), 52 patients (91.2%) remained free from syncope. Prodromes recurred in 16 patients. No statistical differences were found between the high‐frequency stimulation and anatomically guided ablation groups in either freedom from syncope (100% versus 89.4%, P=0.348) or recurrent prodromes (50% versus 76.6%, P=0.167). The deceleration capacity, heart rate, and heart rate variability measurements demonstrated a reduced vagal tone lasting for at least 12 months after the procedure, with improved tolerance of repeated head‐up tilt testing. No complications were observed except for transient sinus tachycardia that occurred in 1 patient.ConclusionsLeft atrial GP ablation showed excellent long‐term clinical outcomes and might be considered as a therapeutic option for patients with symptomatic vasovagal syncope.

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Section: Discussionmentioning

confidence: 99%

Catheter Ablation as a Treatment for Vasovagal Syncope: Long‐Term Outcome of Endocardial Autonomic Modification of the Left Atrium

Sun

Zheng

et al. 2016

JAHA

119

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“…ARGP and IRGP locate in the superoanterior area around the root of the right superior pulmonary vein and the inferoposterior area around the root of the right inferior pulmonary vein, respectively. Anatomically, these two GPs can be accessed through the right atrium and venae cavae . Ablation of only ARGP and IRGP may not need interatrial septal puncture and will be less time‐consuming.…”

Section: Discussionmentioning

confidence: 99%

Selective ablation of atrial ganglionated plexus attenuates vasovagal reflex in a canine model

Wang

Luo

Liu

et al. 2018

Pacing Clinical Electrophis

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Background Atrial ganglionated plexus (GP) ablation was proved to have therapeutic effects on vasovagal syncope. The study aimed to investigate whether selective ablation of only right anterior GP (ARGP) and right inferior GP (IRGP) was effective in a canine model of vasovagal syncope. Methods Seventeen mongrel dogs were divided into control (N = 10) and ablation group (N = 7). Bilateral thoracotomy was performed at the fourth intercostal space and ARGP and IRGP were ablated in the ablation group. A bolus of veratridine (15 ug/kg) was injected into the left atrium to induce vasovagal reflex. Surface electrocardiogram and blood pressure (BP) were continuously monitored. Heart rate (HR) variability was calculated to represent cardiac autonomic tone. Results Veratridine injection induced vasovagal reflex in all dogs. HR decreased from 149 ± 17 to 89 ± 33 beats/min (P < 0.001) in the control group, while in the ablation group HR decreased from 141 ± 35 to 125 ± 34 beats/min (P = 0.032). The postveratridine HR in the ablation group was significantly higher than that in the control group (P = 0.045). A significantly less intense HR decrease was observed in the ablation group compared with control (–17 ± 16 vs –61 ± 34 beats/min, P = 0.006). Significant BP decreases were induced in both the groups (all P < 0.01), while no evident differences in postveratridine BP and the extent of BP decreases were found between the groups. HR variability revealed significant decrease in cardiac vagal tone after ablation [high‐frequency power, 0.50 (0.17–1.05) vs 6.28 (0.68–8.99) ms2, P = 0.005]. Conclusions Selective ablation of ARGP + IRGP weakened cardiac parasympathetic control and significantly attenuated the cardioinhibitory response in an animal model of vasovagal reflex. This ablation strategy might be effective for vasovagal syncope with evident cardioinhibitory response.

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“…This procedure has been referred to as cardioneuroablation and the initial reports from few centers are encouraging and have markedly reduced the recurrences in patients with refractory syncope. [96][97][98][99] These results need to be confirmed, however, in large randomized controlled trials.…”

Section: Cardioneuroablationmentioning

confidence: 95%

Syncope in Children and Adolescents

Kanjwal

Calkins

2015

Cardiology Clinics

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Ganglionated plexi ablation in right atrium to treat cardioinhibitory neurocardiogenic syncope

Cited by 32 publications

References 12 publications

Catheter Ablation as a Treatment for Vasovagal Syncope: Long‐Term Outcome of Endocardial Autonomic Modification of the Left Atrium

Catheter Ablation as a Treatment for Vasovagal Syncope: Long‐Term Outcome of Endocardial Autonomic Modification of the Left Atrium

Selective ablation of atrial ganglionated plexus attenuates vasovagal reflex in a canine model

Syncope in Children and Adolescents

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