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Background: Cardio neuroablation (CNA) is a lesser-known technique for management of patients withexcessive vagal activation on the basis of radiofrequency catheter ablation (RFCA) of the areas related tothe three main autonomic ganglia around the heart. We investigated the effectiveness of selective and/orstepwise RFCA of these areas via right atrium (RA) and/or left atrium (LA) in the patients with recurrentsyncope due to excessive vagal activity. Methods: Twenty-two patients presenting symptomatic functional bradyarrhythmias, neurallymediated reflex syncope (NMS), symptomatic atrioventricular (AV) block, and symptomatic sinus nodedysfunction (SND; number ¼ 8, 7, 7, respectively) were enrolled. The three main paracardiac gangliawere targeted via RA and LA in the patients with NMS and SND. The procedure was performed via RA inthe patients with AV block, followed by RFCA of all ganglia via LA, if AV conduction disorder persists. Thesites showing fragmented potentials were identified by electrical mapping and verified by high-frequencystimulation and ablated until atrial electrical potential was completely eliminated (,0.1 mV). Results: The patients with NMS and SND were free from new syncopal episode at a mean 12.3 +3.4 months and 9.5 + 3.1 months follow-up, respectively. Ablation from RA was successful in six of sevenpatients with AV block. Despite the increased heart rate, the resolution of AV block after the RFCA couldnot be achieved in one patient who had partial resolution with atropine infusion on admission. Conclusion: CNA may be an alternative and safe strategy to reduce NMS episodes, and to treatfunctional AV block and symptomatic SND, especially in young patients. Background: The substrates of supraventricular tachycardia (SVT) are often associated with right atrial isomerism (RAI) and left atrial isomerism (LAI) that are candidates for total cavopulmonary connection (TCPC) procedure. Since SVT can be a serious complication and is mostly difficult to be cured by catheter ablation (CA) because of access limitation to the heart after TCPC. Therefore, pre-operative electrophysiological evaluation seems important to prospect the risk of SVT. The purpose of this study is to delineate the incidence of arrhythmogenic substrates in TCPC candidates with isomerism and evaluate the result of prophylactic CA before TCPC. Patients: From January 2010 to December 2015, we performed electrophysiological study (EPS) upon 20 consecutive patients (RAI in 15 and LAI in 5) before TCPC. Median age was 3 years and median weight was 13 kg. Spontaneous narrow QRS tachycardia had been demonstrated at the palliative operation and/or diagnostic catheterization in all patients. All patients were associated with complete atrioventricular (AV) septal defect. Results: We confirmed that distinct His bundle electrograms recorded at the anterior aspect (1 patients) the posterior aspect (2 patients) or both sides of the common AV valve (17 patients). The type of SVT was AV reentrant tachycardia (AVRT) involving twin AV nodes in 12 patie...

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