Catheter-Based Cardio-Neural Ablation for Refractory Vasovagal Syncope

Lu, Yu; Wei, Wei; Upadhyay, Gaurav A.; Tung, Roderick

doi:10.1016/j.jaccas.2020.04.022

Cited by 10 publications

(15 citation statements)

References 11 publications

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“…1 Catheter-based CNA is emerging as a novel treatment for both cardioinhibitory and vasodepressor VVS. [2][3][4][5][6] Pachon et al first reported successful vagal denervation via RF catheter ablation targeting GPs in a cohort of 21 patients, including six with neurally mediated reflex syncope, seven with functional high-grade atrioventricular block, and 13 with sinus node dysfunction. Success was demonstrated in all cases with relief of symptoms at a mean follow-up point of 9.2 months.…”

Section: Discussionmentioning

confidence: 99%

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Fractionation Mapping of the Ganglionated Plexi for Cardioneuroablation

John¹,

Mullis²,

Payne³

et al. 2021

J Innov Cardiac Rhythm Manage.

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Cardioneuroablation (CNA) is an emerging technique used to treat patients with vasovagal syncope (VVS). We herein describe a case of CNA targeting the atrial ganglionated plexi (GPs) based upon anatomical landmarks and fractionated electrogram (EGM) localization in a 20-year-old healthy female who presented to our center with malignant VVS and symptomatic sinus pauses, the longest of which measured 10 seconds. She underwent acutely successful CNA with a demonstration of vagal response noted following ablation of the left-sided GPs, and tachycardia was noted with right-sided GP ablation. All GP sites were defined by anatomical landmarks and EGM analysis. By using the fractionation mapping software of the EnSite Precision™ cardiac mapping system (Abbott, Chicago, IL, USA) with high-density mapping, fragmented EGMs were successfully detected in each GP site. One month after vagal denervation, no recurrent syncopal episodes or sinus pauses had been recorded. Longer-term follow-up with an implantable loop recorder is planned. Broadly, we performed CNA in a patient with VVS by combining highdensity mapping and fractionation mapping software in a novel approach, which allowed us to detect fractionation in all GP sites and demonstrate an acute vagal response. This workflow may facilitate the introduction of a standardized technique suitable for widespread use.

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Section: Discussionmentioning

confidence: 99%

“…2 Cardioneuroablation (CNA) is an emerging and promising technique to treat patients with both types of VVS. [2][3][4][5][6] We describe a case of CNA targeting the atrial ganglionated plexi (GPs) based on anatomical landmarks and fractionated electrogram (EGM) characteristics in a young patient with cardioinhibitory syncope.…”

Section: Introductionmentioning

confidence: 99%

Fractionation Mapping of the Ganglionated Plexi for Cardioneuroablation

John¹,

Mullis²,

Payne³

et al. 2021

J Innov Cardiac Rhythm Manage.

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“…Refractory syncopal episodes can cause serious syncope‐related injury and can be debilitating for patients with such episodes 2 . VVS is commonly the result of an abnormal Bezold‐Jarisch reflex and can present as two primary types: cardioinhibitory and vasodepressor 1,3 . Cardioneuroablation is an emerging and promising technique to treat patients with both types of VVS 2–6 .…”

Section: Introductionmentioning

confidence: 99%

“…2 VVS is commonly the result of an abnormal Bezold-Jarisch reflex and can present as two primary types: cardioinhibitory and vasodepressor. 1,3 Cardioneuroablation is an emerging and promising technique to treat patients with both types of VVS. [2][3][4][5][6] We describe a case of CNA targeting atrial ganglionated plexi based on anatomical landmarks and fractionated EGM characteristics in a young patient with cardioinhibitory syncope.…”

Section: Introductionmentioning

confidence: 99%

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Cardioneuroablation for cardioinhibitory vasovagal syncope

John

Mullis

Payne

et al. 2021

Cardiovasc electrophysiol

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Background Cardioneuroablation (CNA) is an emerging technique being used to treat patients with cardioinhibitory vasovagal syncope (VVS). We describe a case of CNA in targeting atrial ganglionated plexi (GP) based upon anatomical landmarks and fractionated electrogram (EGM) localization in a patient with cardioinhibitory syncope. Case Presentation A 20‐year‐old healthy female presented with malignant VVS and symptomatic sinus pauses, with the longest detected at 10 s. She underwent acutely successful CNA with demonstration of vagal response (VR) noted after ablation of left sided GP, and tachycardia noted with right sided GP ablation. All GP sites were defined by anatomical landmarks and EGM analysis. By using the fractionation mapping software of Ensite Precision mapping system with high density mapping, fragmented EGMs were successfully detected in each GP site. One month after vagal denervation, there were no recurrent syncopal episodes or sinus pauses. Longer term follow‐up with implantable loop recorder is planned. Conclusion We performed CNA in a patient with VVS by utilizing a novel approach of combined use of high density mapping and fractionation mapping software. With this approach, we were able to detect fractionation in all GP sites and demonstrate acute VR. This workflow may allow for a new, standardized technique suitable for widespread use.

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