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Extracardiac Vagal Stimulation-Assisted Cardioneuroablation: Dynamically Evaluating the Impact of Sequential Ganglionated Plexus Ablation on Vagal Control of SAN and AVN in Patients with Sinoatrial Node Dysfunction

Authors :
Weijie Chen
Zengzhang Liu
Peilin Xiao
Yanping Xu
Dan Li
Qingsong Xiong
Lili Zou
Fang Qin
Xiexin Tao
Junan Chen
Xianbin Lan
Huaan Du
Yuehui Yin
Zhiyu Ling
Source :
Journal of Cardiovascular Development and Disease, Vol 9, Iss 6, p 188 (2022)
Publication Year :
2022
Publisher :
MDPI AG, 2022.

Abstract

Cardioneuroablation (CNA) is proposed as a promising therapy for patients with sinoatrial node dysfunction (SND) that is mediated by excessive vagal tone. However, a series of urgent questions about CNA remain unanswered. From December 2020 to March 2022, six patients with symptomatic SND who underwent CNA were summarized in this report. Sequential CNA targeting Ao-SVC GP, PMLGP, RAGP, and LSGP was performed in patients, guided by fractionated intracardiac electrograms and dynamically evaluated by extracardiac vagal stimulation (ECVS). The results showed that Ao-SVC GP ablation led to a significant increase in heart rate (HR) and the elimination of sinus arrest evoked by ECVS, while the vagal responses of atrial ventricular block were eliminated by the ablation of PMLGP and LSGP. Post-procedure HR increased up to 64–86% of the maximum HR of an atropine test at baseline. The median HR from Holter monitoring increased from 52.8 ± 2.1 bpm at baseline to 73.0 ± 10.4 bpm after the procedure (p = 0.012) and to 71.3 ± 10.1 bpm at the six-month follow-up (p = 0.011). Bradycardia-related symptoms disappeared in all patients at the six-month follow-up. This case series reveals the feasibility of using the ECVS-assisted sequential CNA technique and indicates the critical role of ECVS in dynamically evaluating the impact of sequential CNA on the vagal control of SAN and AVN.

Details

Language :
English
ISSN :
23083425
Volume :
9
Issue :
6
Database :
Directory of Open Access Journals
Journal :
Journal of Cardiovascular Development and Disease
Publication Type :
Academic Journal
Accession number :
edsdoj.6fa29b7717405faff4ec23d1bb72ee
Document Type :
article
Full Text :
https://doi.org/10.3390/jcdd9060188