Potential usage of cardioneuroablation in vagally mediated functional atrioventricular block

Abstract

An increase in parasympathetic tone may be the main cause of some transient or permanent atrioventricular block cases. Some of these patients, defined as vagally mediated functional atrioventricular block, may be severely symptomatic and refractory to conventional therapies and may necessitate cardiac pacing. Cardioneuroablation is a relatively new strategy for management of patients with excessive vagal activation based on radiofrequency catheter ablation of main ganglionated plexi around the heart. Present review was dedicated to discuss potential usage of cardioneuroablation in patients with vagally mediated functional atrioventricular block.

Long-term Success of Cardioneuroablation in a Patient with Tachycardia–bradycardia Syndrome and Syncope

“…Young patients with fainting due to the neurocardiogenic syncope with a cardioinhibitory reaction are the most frequent candidates for CNA. 5 , 7 This procedure could become an alternative intervention for symptomatic bradyarrhythmia treatment, giving a chance to avoid PM in some patients, but additional investigation and accurate patient selection are necessary prior to the decision about the type of procedure needed.…”

“…In some patients, pathogenic parasympathetic tone could be eliminated by additional ablation lesions in other regions (superoposterior wall of the right atrium, coronary sinus ostium, right pulmonary artery) guided by the characteristics of local atrial electrograms, fluoroscopy, or non-fluoroscopic three-dimensional mapping. 5 But none of these lesion sets are included in the regular procedure for AF-related bradycardia. 1…”

Catheter Ablation of Atrioventricular Block

“…Intrinsic AVB is usually initiated by premature extrasystoles, and sinus rate acceleration is observed during the block ( 4 ). Conversely, AVB is often accompanied by slowing of the sinus rate in functional AVB, and progressive PR interval prolongation preceding the AVB may also be seen.…”

Atrioventricular Block of Dyasautonomic Origin Complicated by Ventricular Asystole: A Case Report

“…Vagally mediated atrioventricular block is a functional and paroxysmal conduction disorder related to the parasympathetic influence on atrioventricular conduction [5] and is characterized by narrow QRS complexes [6]. It can occur acutely, during stimulation of the parasympathetic system (during vagal stimulation, carotid sinus massage, emotion, etc.…”