Recurrent vasovagal syncope following successful cardioneuroablation

Thurber, Clinton J.; Sneider, Davis R.; Sauer, William H.; Kapur, Sunil

doi:10.1016/j.hrcr.2022.04.001

Cited by 8 publications

(8 citation statements)

References 13 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…There are few reports in the literature describing CNA as a treatment for carotid sinus syndrome, 11 or addressing recurrence situations, 12 or describing applicability as a redo procedure, and no information about recurrence predictors. We consider that partial or low-level parasympathetic denervation, reinnervation process, variations in GP locations, and low predictive value of increased heart rate and atropine response as endpoints were decisive predictors of recurrence in this case.…”

Section: Discussionmentioning

confidence: 99%

Carotid sinus syndrome treated by cardioneuroablation: Is sinus node denervation enough? Insights from a syncope recurrence report

Acosta¹,

Souza²,

Ortencio³

et al. 2023

HeartRhythm Case Reports

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

Carotid sinus syndrome treated by cardioneuroablation: Is sinus node denervation enough? Insights from a syncope recurrence report

Acosta¹,

Souza²,

Ortencio³

et al. 2023

HeartRhythm Case Reports

View full text Add to dashboard Cite

“…Ablation of right-sided GPs is proving to be an attractive alternative to pacemaker implantation [ 91 , 92 ]. GP ablation alone has also been successfully used for the treatment of sinus bradycardia [ 93 ]; however, a recent case study highlighted the question around the potential for reinnervation after GP ablation; in this instance, GP ablation was successful acutely, but an implanted monitor provided evidence of a gradual recovery of autonomic innervation and associated return in syncopal events [ 94 ]. This reinnervation issue has already been reported in pre-clinical studies of GP ablation for the treatment of AF [ 95 , 96 ]; the main concern is that hyper-innervation after ablation may be proarrhythmic.…”

Section: Discussionmentioning

confidence: 99%

Cardioneuroablation Using Epicardial Pulsed Field Ablation for the Treatment of Atrial Fibrillation

O’Brien¹,

Reilly²,

Coffey³

et al. 2023

JCDD

View full text Add to dashboard Cite

Atrial fibrillation (AF) is the most common cardiac arrhythmia affecting millions of people worldwide. The cardiac autonomic nervous system (ANS) is widely recognized as playing a key role in both the initiation and propagation of AF. This paper reviews the background and development of a unique cardioneuroablation technique for the modulation of the cardiac ANS as a potential treatment for AF. The treatment uses pulsed electric field energy to selectively electroporate ANS structures on the epicardial surface of the heart. Insights from in vitro studies and electric field models are presented as well as data from both pre-clinical and early clinical studies.

show abstract

“…Было выявлено, что аблация ГС вызвала среднее острое удлинение ЭРП предсердий на 80 мс. Однако, через 4 месяца после аблации ЭРП предсердий укорачивался, что может быть объяснено реиннервацией [25]. Сходные результаты были получены в другом хроническом экспериментальном исследовании у собак, где проводилась аблация ГС в правом предсердии [26].…”

Section: рис 7 коагуляционный некроз нервного ганглия в зоне аблации ...unclassified

Laser catheter ablation of atrial zones with ganglionated plexi: impact on atrial fibrillation inducibility and the risk of esophageal damage in experimental settings

Vakhrushev,

Condori Leandro,

Korobchenko

et al. 2024

Vestnik aritmologii

View full text Add to dashboard Cite

Aim. To study the potential applicability of transcatheter laser ablation for the destruction of atrial ganglionated plexi (GP) zones and the safety of this technique in relation to inadvertent esophageal damage.Methods. This was a two-stage investigation: (1) ex vivo experiments: the risk of esophageal damage during ablation on the dorsal (posterior) left atrial (LA) wall was assessed; three swine organ complexes were used, which included the heart, lungs and esophagus; (2) in vivo experiments assessing the effects of laser catheter ablation of GP zones on the inducibility of atrial fibrillation (AF) and changes in atrial effective refractory period - included 13 landrace pigs (average weight 38.8±1.2 kg).Ex vivo: laser catheter ablations were performed from the endocardial surface of the LA towards the esophagus with a power of 15 watts of varying duration; ablation was performed under thermal scanning of the LA and esophagus; then a macroscopic examination of the myocardial and esophageal walls was performed.In vivo: before and after catheter laser ablation (15 W) of the GP zones in the right atrium and atrial septum, atrial ERP was assessed with programmed stimulation, and AF induction with high-frequency (33 Hz, 2 min) stimulation was evaluated. At the end of the experiment, the animals were euthanized, and the heart and lungs were collected in a single unit.Results. Ex vivo experiments: in two cases, damage to the endocardium of the LA was detected at an exposure time of 30 s. Damage to the esophagus was observed with a longer exposure time (> 30 seconds) with a 11.3-15.4°C increase in temperature. In the in vivo experiments, 78 laser applications (6±1 in one swine) were delivered to the posterior wall of the right atrium and atrial septum. Atrial effective refractory period was not altered after ablation (183±20 ms vs 186±18 ms, P=0.99). At the baseline, AF was induced in 12 out of 13 animals (92%). After ablation, AF was induced in 7 animals (54%) (P=0.03). There was a trend toward a decrease in the duration of AF after laser ablation of GP zones (18 [5; 141] vs. 2 [0; 14] s after ablation, P=0.06). Transmural damage was observed in 46% of the hearts. No damage to extra-cardiac structures was detected.Conclusion. Ex vivo, laser ablation on the dorsal (posterior) wall of the LA with a power of 15 W and duration <30 s does not lead to visible damage to the esophagus. Laser ablation of atrial GP zones is feasible and reduces the inducibility of AF. No change in atrial effective refractory period is detected following GP zones ablation, when performed from the right atrium.

show abstract

Recurrent vasovagal syncope following successful cardioneuroablation

Cited by 8 publications

References 13 publications

Carotid sinus syndrome treated by cardioneuroablation: Is sinus node denervation enough? Insights from a syncope recurrence report

Carotid sinus syndrome treated by cardioneuroablation: Is sinus node denervation enough? Insights from a syncope recurrence report

Cardioneuroablation Using Epicardial Pulsed Field Ablation for the Treatment of Atrial Fibrillation

Laser catheter ablation of atrial zones with ganglionated plexi: impact on atrial fibrillation inducibility and the risk of esophageal damage in experimental settings

Contact Info

Product

Resources

About