Initial Experience with Fractionation Mapping in the Identification of Vagal Ganglionated Plexus During Cardioneuroablation

Fabricio Vassallo; Edevaldo da Silva; Lucas Luis Meigre; Christiano Cunha; Eduardo Serpa; Aloyr Simões Jr; Hermes Carloni; Carlos Volponi

Authors

Fabricio Vassallo Instituto de Cardiologia do Espírito Santo
Edevaldo da Silva St Jude Medical / Abbott – São Paulo (SP), Brazil.
Lucas Luis Meigre Instituto de Cardiologia do Espírito Santo – Vitória (ES), Brazil.
Christiano Cunha Instituto de Cardiologia do Espírito Santo – Vitória (ES), Brazil.
Eduardo Serpa Instituto de Cardiologia do Espírito Santo – Vitória (ES), Brazil.
Aloyr Simões Jr Instituto de Cardiologia do Espírito Santo – Vitória (ES), Brazil.
Hermes Carloni Instituto de Cardiologia do Espírito Santo – Vitória (ES), Brazil.
Carlos Volponi Instituto de Cardiologia do Espírito Santo – Vitória (ES), Brazil.

Keywords:

Cardioneuroablation, Electroanatomical mapping, Syncope, Bradycardia, Atrioventricular Block/Congenital

Abstract

This is a series case report of five symptomatic patients presented with diagnosis of sinus bradycardia, first and second degrees atrioventricular (AV) blocks, that were referred to pacemaker implantation. During the screening, a functional cause for the bradycardia and AV blocks were documented by treadmill stress test, 24-hour Holter monitoring and atropine test. After the confirmation of the diagnosis, patients were submitted to cardioneuroablation on an anatomical basis supported by a tridimensional electroanatomical fractionation mapping software. The technique and the acute and short-term results of the cardioneuroablation are described.

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References

Pachón JC, Pachón EI, Pachón JC, Lobo TJ, Pachón MZ, Vargas RNA, et al. “Cardioneuroablation” — New treatment for neurocardiogenic syncope, functional AV block and sinus dysfunction using catheter RF-ablation. Europace. 2005;7(1):1-13. https://doi.org/10.1016/j.eupc.2004.10.003

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(2):289-98. https://doi.org/10.1002/(SICI)1097-0185(199702)247:2%3C289::AID-AR15%3E3.0.CO;2-L

Pachón MJC, Pachón MEI, Lobo TJ, Pachón JC, Pachón MZC, Vargas RNA, et al. Syncopal high degree AV block treated with catheter RF ablation without pacemaker implantation. Pacing Clin Electrophysiol. 2006;29(3):318-22. https://doi.org/10.1111/j.1540-8159.2006.00340.x

Rivarola E, Hardy C, Sosa E, Hachul D, Furlan V, Raimundi F, et al. Selective atrial vagal denervation guided by spectral mapping to treat advanced atrioventricular block. Europace. 2016;18(3):445-9. https://doi.org/10.1093/europace/euv142

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(1):42-53. https://doi.org/10.1111/pace.12756

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(2):279-86. https://doi.org/10.1161/circep.111.966465

Fukunaga M, Wichterle D, Peichi P, Aldhoon B, Cihak R, Kautzner J. Differential effect of ganglionic plexi ablation in a patient with neutrally mediated syncope and intermittent atrioventricular block. Europace. 2017;19(1):119-26. https://doi.org/10.1093/europace/euw100

Epstein AE, DiMarco JP, Ellenbogen KA, Estes NA 3rd, Freedman RA, Gettes LS, et al. 2012 ACCF/AHA/HRS focused update incorporated into ACCF/AHA/HRS 2008 guidelines for device-based therapy of cardiac rhythm abnormalities: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2013;61(3):e6-75. https://doi.org/10.1016/j.jacc.2012.11.007

Aksu T, Guler TE. Cardioneuroablation in the management of vasovagal syncope, sinus node dysfunction and functional atrioventricular block: patient selection based on supporting evidence. J Atr Fibrillation. 2020;13(1):2396. https://dx.doi.org/10.4022%2Fjafib.2396

Pachón JCM, Pachón EIM, Higuti C, Lobo TJ, Santillana TGP, Pachón CTC, et al. Cardioneuroablation: catheter vagal denervation as a new therapy for cardioinhibitory syncope. J Cardiac Arrythmias. 2019;32(3):182-96. https://doi.org/10.24207/jca.v32n3.067_IN

Lellouche N, Buch E, Celigoj A, Siegerman C, Cesario D, Diego C, et al. Functional characterization of atrial electrograms in sinus rhythm delineates sites of parasympathetic innervation in patients with paroxysmal atrial fibrillation. J Am Coll Cardiol. 2007;50(14):1324-

https://doi.org/10.1016/j.jacc.2007.03.069

Vassallo F, da Silva E, Serpa E, Simões Jr. A, Carloni H, Cunha C, et al. Validation of complex fractionated electrograms mapping in the identification of vagal ganglionated plexux during cardioneuroablation. Annal Cas Rep Rev. 2020;12:1-6. https://doi.org/10.39127/2574-5747/ACRR:1000181

Osorio J, Doud DM, Aksu T. Fractionation mapping by using a high-density catheter to map ganglionated plexus sites during sinus rhythm. J Innov Cardiac Rhythm Manag. 2021;12(Suppl. 1):7-8. https://dx.doi.org/10.19102%2Ficrm.2021.120110S

Aksu T, Guler TE, Bozyel S, Yalin K. Usage of a new mapping algorithm to detect possible critical substrate for continuity of atrial fibrillation: fractionation mapping in preliminary experience. J Interv Card Electrophysiol. 2020;58(1):29-34. https://doi.org/10.1007/s10840-019-00693-x

Aksu T, Guler TE. Electroanatomical mapping-guided ablation during atrial fibrillation: a novel usage of fractionation mapping in a case with sinus bradycardia and paroxysmal atrial fibrillation. J Interv Card Electrophysiol. 2020;57(2):331-2. https://doi.org/10.1007/s10840-019-00633-9

Aksu T, Yalin K, Gopinathannair R. Fractionation mapping software to map ganglionated plexus sites during sinus rhythm. 2020;31(12):3326-9. https://doi.org/10.1111/jce.14753