Step-by-Step Cardioneuroablation Approach in Two Patients with Functional Atrioventricular Block

Step-by-Step Cardioneuroablation Approach in Two Patients with Functional Atrioventricular Block

Parasympathetic overactivity may cause functional atrioventricular block episodes and necessitate pacemaker implantation in symptomatic cases and those refractory to conventional therapies. In these patients, if it can be clearly demonstrated that there is no structural damage in the conduction system, elimination of the vagal activity based on radiofrequency catheter ablation of main ganglionated plexi around the heart, which is called as cardioneuroablation, might be a rational approach. In this review article, we try to discuss patient selection and procedural steps suitable for cardioneuroablation based on two patients with functional atrioventricular block.

___

  • Brignole M, Deharo JC, Guieu R. Syncope and Idiopathic (Paroxysmal) AV Block. Cardiol Clin 2015;33:441-7.
  • Bartoletti A, Fabiani P, Bagnoli L, Cappelletti C, Cappellini M, Nappini G, et al. Physical injuries caused by a transient loss of consciousness: main clinical characteristics of patients and diagnostic contribution of carotid sinus massage. Eur Heart J 2008;29:618-24.
  • Rose MS, Koshman ML, Spreng S, Sheldon R. The relationship between health-related quality of life and frequency of spells in patients with syncope. J Clin Epidemiol 2000;53:1209-16.
  • Pachon JC, Pachon EI, Pachon JC, Lobo TJ, Pachon MZ, Vargas RN, et al. “Cardioneuroablation”-new treatment for neurocardiogenic syncope, functional AV block and sinus dysfunction using catheter RF-ablation. Europace 2005;7:1-13.
  • Aksu T, Golcuk E, Yalin K, Guler TE, Erden I. Simplified cardioneuroablation in the treatment of reflex syncope, functional AV block, and sinus node dysfunction. Pacing Clin Electrophysiol 2016;39:42-53.
  • Aksu T, Guler TE, Mutluer FO, Bozyel S, Golcuk SE, Yalin K. Electroanatomic-mapping-guided cardioneuroablation versus combined approach for vasovagal syncope: a cross-sectional observational study. J Interv Card Electrophysiol 2019;54:177-88.
  • Aksu T, Güler TE, Bozyel S, Özcan KS, Yalın K, Mutluer FO. Cardioneuroablation in the treatment of neurally mediated reflex syncope: a review of the current literature. Turk Kardiyol Dern Ars 2017;45:33-41.
  • Zyśko D, Gajek J, Koźluk E, Mazurek W. Electrocardiographic characteristics of atrioventricular block induced by tilt testing. Europace 2009;11:225-30.
  • Aksu T, Guler TE, Bozyel S, Yalin K. Potential usage of cardioneuroablation in vagally mediated functional atrioventricular block. SAGE Open Med 2019;7:2050312119836308.
  • Brignole M, Auricchio A, Baron-Esquivias G, Bordachar P, Boriani G, Breithardt OA, et al. 2013 ESC guidelines on cardiac pacing and cardiac resynchronization therapy: the task forceon cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). Europace 2013;15:1070-118.
  • Aksu T, Güler TE, Yalın K, Bozyel S, Mutluer FO. A new and simple technique for vagal ganglia ablation in a patient with functional atrioventricular block: Electroanatomical approach. Turk Kardiyol Dern Ars 2018;46:494-500.
  • Aksu T, Golcuk SE, Erdem Guler T, Yalin K, Erden I. Functional permanent 2:1 atrioventricular block treated with cardioneuroablation: Case report. HeartRhythm Case Rep 2015;1:58-61.
  • Hazinski MF, Nolan JP, Aickin R, Bhanji F, Billi JE, Callaway CW, et al. Part 1: Executive Summary: 2015 International Consensus on Cardiopulmonary Resuscitation and Emergency Cardiovascular Care Science With Treatment Recommendations. Circulation 2015;132(16 Suppl 1):S2-39.
  • Aksu T, Guler TE, Yalin K, Mutluer FO, Ozcan KS, Calò L. Catheter Ablation of Bradyarrhythmia: From the Beginning to the Future. Am J Med Sci 2018;355:252-65.
  • Chiou CW, Eble JN, Zipes DP. Efferent vagal innervation of the canine atria and sinus and atrioventricular nodes. The third fat pad. Circulation 1997;95:2573-84.
  • Armour JA, Murphy DA, Yuan BX, Macdonald S, Hopkins DA. Gross and microscopic anatomy of the human intrinsic cardiac nervous system. Anat Rec 1997;247:289-98.
  • Billman GE, Hoskins RS, Randall DC, Randall WC, Hamlin RL, Lin YC. Selective vagal postganglionic innervation of the sinoatrial and atrioventricular nodes in the non-human primate. J Auton Nerv Syst 1989;26:27-36.
  • Tanaka K, Zlochiver K, Vikstrom KL, Yamazaki M, Moreno J, Klos M, et al. Spatial distribution of fibrosis governs fibrillation wave dynamics in the posterior left atrium during heat failure. Circ Res 2007;101:839-47.
  • Jadidi AS, Cochet H, Shah AJ, Kim SJ, Duncan E, Miyazaki S, et al. Inverse relationship between fractionated electrograms and atrial fibrosis in persistent atrial fibrillation: combined magnetic resonance imaging and high-density mapping. J Am Coll Cardiol 2013;62:802-12.
  • Ullah W, Hunter RJ, Baker V, Ling LH, Dhinoja MB, Sporton S, et al. Impact of Catheter Contact Force on Human Left Atrial Electrogram Characteristics in Sinus Rhythm and Atrial Fibrillation. Circ Arrhythm Electrophysiol 2015;8:1030-9.
  • Quan KJ, Lee JH, Van Hare GF, Biblo LA, Mackall JA, Carlson MD. Identification and characterization of atrioventricular parasympathetic innervation in humans. J Cardiovasc Electrophysiol 2002;13:735-9.
  • Hu F, Zheng L, Liang E, Ding L, Wu L, Chen G, et al. Right anterior ganglionated plexus: the primary target of cardioneuroablation? Heart Rhythm 2019;16:1545-51.
  • Hou Y, Scherlag BJ, Zhou J, Song J, Patterson E, Lazzara R, et al. Po SS: Interactive atrial neural network: Determining the connec-tions between ganglionated plexi. Heart Rhythm 2007;4:56-63.
  • Malcolme-Lawes LC, Lim PB, Wright I, Kojodjojo P, Koa-Wing M, Jamil-Copley S, et al. Characterization of the left atrial neural network and its impact on autonomic modification procedures. Circ Arrhythm Electrophysiol 2013;6:632-40.
  • Randall WC, Ardell JL, O’Toole MF, et al. Differential autonomic control of SAN and AVN regions of the canine heart: Structure and function. Prog Clin Biol Res 1988;275:15-31.
  • McGuire MA, de Bakker JM, Vermeulen JT, Opthof T, Becker AE, Janse MJ. Origin and significance of double potentials near the atrioventricular node. Correlation of extracellular potentials, intracellular potentials, and histology. Circulation 1994;89:2351-60. Yao Y, Shi R, Wong T, Zheng L, Chen W, Yang L, et al. Endocardial autonomic denervation of the left atrium to treat vasovagal syncope: an early experience in humans. Circ Arrhythm Electrophysiol 2012;5:279-86.
  • Sun W, Zheng L, Qiao Y, Shi R, Hou B, Wu L, et al. Catheter Ablation as a Treatment for Vasovagal Syncope: Long-Term Outcome of Endocardial Autonomic Modification of the Left Atrium. J Am Heart Assoc 2016;5. pii:e003471.
  • Pachon MJC, Pachon MEI, Pachon MJC, Lobo TJ, Pachon MZ, Vargas RN, et al. A new treatment for atrial fibrillation based on spectral analysis to guide the catheter RF-ablation. Europace 2004;6:590-601.
  • Rebecchi M, de Ruvo E, Strano S, Sciarra L, Golia P, Martino A, et al. Ganglionated plexi ablation in right atrium to treat cardioinhibitory neurocardiogenic syncope. J Interv Card Electrophysiol 2012;34:231-5.
  • Debruyne P, Rossenbacker T, Collienne C, Roosen J, Ector B, Janssens L, et al. Unifocal Right-Sided Ablation Treatment for Neurally Mediated Syncope and Functional Sinus Node Dysfunction Under Computed Tomographic Guidance. Circ Arrhythm Electrophysiol 2018;11:e006604.
  • Rivarola EW, Hachul D, Wu T, Pisani C, Hardy C, Raimundi F, et al. Targets and endpoints in cardiac autonomic denervation procedures. Circ Arrhythm Electrophysiol 2017;10:e004638.
  • Barra S, Gopalan D, Baran J, Fynn S, Heck P, Agarwal S. Acute and sub-acute sinus node dysfunction following pulmonary vein isolation: a case series. Eur Heart J Case Rep 2018;2:ytx020.
  • Pachon MJC, Pachon MEI, Santillana PTG, Lobo TJ, Pachon CTC, Pachon MJC, et al. Simplified Method for Vagal Effect Evaluation in Cardiac Ablation and Electrophysiological Procedures. JACC Clin Electrophysiol 2015;1:451-60.
Balkan Medical Journal-Cover
  • ISSN: 2146-3123
  • Başlangıç: 2015
  • Yayıncı: Erkan Mor
Sayıdaki Diğer Makaleler

Bilateral Adrenal Histoplasmosis

Sarin KHAHAKAEW, Thachanun PORNTHARUKCHAREON, Leilani PAITOONPONG, Thitiwat SRIPRASART, Thiti SNABBOON

Effect of Echocardiographic Epicardial Adipose Tissue Thickness on Success Rates of Premature Ventricular Contraction Ablation

Selçuk KANAT, Erhan TENEKECİOĞLU, Ferit Onur MUTLUER, Ahmet TÜTÜNCÜ, Bilge DURAN KARADUMAN, Nihal Akar BAYRAM

The Effects of Irisin on Nω-Nitro-L-arginine Methyl Ester Hydrochloride-Induced Hypertension in Rats

Pınar TAYFUR, Oktay KAYA, Nurettin AYDOĞDU, Ebru TAŞTEKİN, Nihayet KANDEMİR, Özlem YALÇINKAYA YAVUZ

Congenital Heart Disease in Asymptomatic Neonates with Extra-Cardiac Malformations and Genetic Disorders

Ageliki A. KARATZA, Gabriel DIMITRIOU, Despoina GKENTZI, Olga PANAGIOTOPOULOU

The Prevalence of Fabry Disease Among Turkish Patients with Non-Obstructive Hypertrophic Cardiomyopathy: Insights from a Screening Study

Adem ATICI, Burçak KILIÇKIRAN AVCI, Barış İKİTİMUR, Hakan KARPUZ, Serkan ASLAN, Serdar CEYLANER, Hasan Ali BARMAN, Eser DURMAZ

Limited Vitrectomy in Patients with Idiopathic Macular Hole

Özgül ALTINTAŞ, Berna ÖZKAN, Veysel Levent KARABAŞ, Büşra Yılmaz TUĞAN

Multiple Thick Nodular Melanoma: Differentiating Multiple Primaries from the Metastasis of a Previous Single Melanoma

Robert A. SCHWARTZ, Ravi J. CHOKSHI, Albert ALHATEM, W. Clark LAMBERT

Alveolar Bone Density Reduction in Rats Caused by Unilateral Nasal Obstruction

Zihan WANG, Zhenhua LIU, Xuanxuan HU, Yongge CAO, Xue WANG, Hui YE, Xiaoying CHU, Han ZHAO, Zhanqiu DIAO, Fengting PENG, Zhensheng CAO, Lei WANG

Acute Unilateral Swelling of Parotid Gland After General Anesthesia: Anesthesia Mumps

Gülsüm EKİN SARI, Selen DOĞAN, Erhan ÖZYURT

Prognostic Effects of Predominant Histologic Subtypes in Resected Pulmonary Adenocarcinomas

Arkın ACAR, Zekiye AYDOĞDU, Soner GÜRSOY, Şeyda ÖRS KAYA, Kenan Can CEYLAN, Sadık YALDIZ, Demet YALDIZ