1. Unifocal Right-Sided Ablation Treatment for Neurally Mediated Syncope and Functional Sinus Node Dysfunction Under Computed Tomographic Guidance
- Author
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Christine Collienne, Bavo Ector, Bart Vankelecom, Luc Janssens, John Roosen, William Wijns, Philippe Debruyne, Tom Rossenbacker, Filip Charlier, Willem Dewilde, and UCL - (SLuc) Service de soins intensifs
- Subjects
Male ,Time Factors ,medicine.medical_treatment ,Sinus bradycardia ,Action Potentials ,030204 cardiovascular system & hematology ,Radiography, Interventional ,0302 clinical medicine ,Belgium ,Heart Rate ,Recurrence ,Tilt-Table Test ,atrioventricular block ,Syncope, Vasovagal ,Medicine ,Prospective Studies ,Sick Sinus Syndrome ,biology ,Syncope (genus) ,Middle Aged ,Ablation ,follow-up studies ,Treatment Outcome ,medicine.anatomical_structure ,Cardioneuroablation ,syncope ,Catheter Ablation ,Cardiology ,Female ,medicine.symptom ,Cardiology and Cardiovascular Medicine ,Adult ,Bradycardia ,medicine.medical_specialty ,bradycardia ,Young Adult ,03 medical and health sciences ,Physiology (medical) ,Internal medicine ,Humans ,Aged ,Plexus ,denervation ,business.industry ,Sinoatrial node ,autonomic nervous system ,medicine.disease ,biology.organism_classification ,Electrocardiography, Ambulatory ,Tomography, X-Ray Computed ,business ,Atrioventricular block ,030217 neurology & neurosurgery - Abstract
Background Biatrial, extensive, and complex ablation strategies have been published for the treatment of neurally mediated syncope, sinus node dysfunction, and functional atrioventricular block. We have developed a less extensive and more specific approach compared with previously published cardioneuroablation strategies, called cardio-neuromodulation. It is based on tailored vagolysis of the sinoatrial node through partial ablation of the anterior right-ganglionated plexus, preferentially through a right-sided approach. Methods Patients with syncope were enrolled between December 2016 and December 2017. They were assigned to group A if they had a positive head-up tilt test and to group B if they presented with a pause ≥3 seconds. The area to target during cardio-neuromodulation was designed offline on a computed tomographic scan. Slow heart rates and pauses were compared during 24-hour rhythm registration at baseline, at 1-month follow-up, and 6-month follow-up. Syncope burden was assessed before the procedure and at 3- and 6-month follow-up. Results Twenty patients underwent cardio-neuromodulation through a right-sided approach (12 in group A, 8 in group B). The first application of radiofrequency energy led to a P-P interval shortening >120 ms in all 20 patients. After a mean±SD ablation time of 7±4 minutes and mean ablated surface area of 11±6 mm 2 , the P-P interval shortened by 219±160 ms ( P P P Conclusions These data indicate that cardio-neuromodulation, through a right-sided and computed tomographic–guided procedure, is safe, fast, and highly reproducible in preventing inappropriate functional sinus bradycardia and syncope recurrence.
- Published
- 2018
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