Vagal responses during cardioneuroablation on different ganglionated plexi: Is there any role of ablation strategy?

Utility of Head up Tilt Table Testing to Demonstrate Selective Denervation of the Sinus Node after Cardioneuroablation

“…In our previous works, no procedure related complication was seen. [13][14][15] Inappropriate sinus Hemodynamical results of the case during tilt testing before the procedure (A) and at 6th months of follow-up after cardioneuroablation (B)…”

Fractionation mapping software to map ganglionated plexus sites during sinus rhythm

“…White areas were accepted as potential GP sites and were compared the areas which were detected using our previously validated fragmented EGM-based GP detection strategy. 7,11 Potential importance of fragmented EGMs during sinus rhythm was first studied by Lellouche et al 12 They found that fragmentation of EGMs was the best single predictor of vagal response during radiofrequency ablation. Then, we retrospectively analyzed our radiofrequency ablation points for EGM characteristics which were detected by using a combination of spectral analysis and high frequency stimulation.…”

“…However, in our recently accepted work, we demonstrated that HUT might be a valuable diagnostic tool not only to select suitable candidates and but also to evaluate success of CNA. 5 By using visual analysis, potential usage of fractionated atrial EGMs to detect localization of GPs was previously investigated by our group 5,7,11,13 and others, 15,16 but decisions made by humans based on visualizations of data may demonstrate low reproducibility. Furthermore, it is not clear if this is a specific marker for GPs.…”

“…White areas were accepted as potential GP sites and were compared the areas which were detected using our previously validated fragmented EGM‐based GP detection strategy 7,11 . Briefly, by using the ablation catheter, fragmented bipolar endocardial atrial EGMs were evaluated for number of deflections at filter settings of 200–500 Hz.…”

“…Both atria were included in the analysis. After all GP targets have been identified, radiofrequency ablation of targeted areas started according to our ablation order of GPs (the Marshall Tract GP, the left superior GP, the right superior GP via the left atrium (LA), the right inferior GP via the LA, and the posteromedial left atrial GP via the LA, respectively 11 . Radiofrequency application at the Marshall Tract GP caused a slight vagal response with sinus bradycardia.…”