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Sinus arrest: A rare observation during radiofrequency ablation along the coronary sinus roof
Catheter‐based radiofrequency (RF) ablation targeting segments of the cardiac conduction system and/or selected regions of myocardium is an accepted treatment for many cardiac arrhythmias. On the other hand, while purposeful extension of RF ablation to include nearby cardiac neural elements, particu...
Autores principales: | , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2020
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7816812/ https://www.ncbi.nlm.nih.gov/pubmed/32672409 http://dx.doi.org/10.1111/anec.12772 |
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author | Nantsupawat, Teerapat Krishnappa, Darshan Benditt, David G. |
author_facet | Nantsupawat, Teerapat Krishnappa, Darshan Benditt, David G. |
author_sort | Nantsupawat, Teerapat |
collection | PubMed |
description | Catheter‐based radiofrequency (RF) ablation targeting segments of the cardiac conduction system and/or selected regions of myocardium is an accepted treatment for many cardiac arrhythmias. On the other hand, while purposeful extension of RF ablation to include nearby cardiac neural elements, particularly epicardial ganglionated plexi (GP), remains a subject of ongoing study, inadvertent stimulation of such structures may occur during an otherwise conventional RF ablation procedure. Thus, asystolic pauses have been observed during RF ablation of left ventricular free‐wall accessory pathways, slow AV node pathways, and the left superior pulmonary vein. In this report, sinus arrest occurred within 3.3 s of RF application (40 W at 50°C) along the coronary sinus roof for treatment of an atypical “slow–slow” atrioventricular nodal reentrant tachycardia. Energy delivery was immediately terminated, but asystole persisted for 4.7 s followed by sinus bradycardia. The procedure was temporarily halted, but later was successfully resumed. Given the latency from terminating RF to return of sinus node function, the sinus arrest was likely a centrally mediated reflex vagal response. Consequently, while parasympathetic ganglia near the CS os are believed to principally innervate the AV node, not the sinus node, our observation highlights the neural cross‐communications that likely exist in this region of the heart. |
format | Online Article Text |
id | pubmed-7816812 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2020 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-78168122021-01-29 Sinus arrest: A rare observation during radiofrequency ablation along the coronary sinus roof Nantsupawat, Teerapat Krishnappa, Darshan Benditt, David G. Ann Noninvasive Electrocardiol Case Reports Catheter‐based radiofrequency (RF) ablation targeting segments of the cardiac conduction system and/or selected regions of myocardium is an accepted treatment for many cardiac arrhythmias. On the other hand, while purposeful extension of RF ablation to include nearby cardiac neural elements, particularly epicardial ganglionated plexi (GP), remains a subject of ongoing study, inadvertent stimulation of such structures may occur during an otherwise conventional RF ablation procedure. Thus, asystolic pauses have been observed during RF ablation of left ventricular free‐wall accessory pathways, slow AV node pathways, and the left superior pulmonary vein. In this report, sinus arrest occurred within 3.3 s of RF application (40 W at 50°C) along the coronary sinus roof for treatment of an atypical “slow–slow” atrioventricular nodal reentrant tachycardia. Energy delivery was immediately terminated, but asystole persisted for 4.7 s followed by sinus bradycardia. The procedure was temporarily halted, but later was successfully resumed. Given the latency from terminating RF to return of sinus node function, the sinus arrest was likely a centrally mediated reflex vagal response. Consequently, while parasympathetic ganglia near the CS os are believed to principally innervate the AV node, not the sinus node, our observation highlights the neural cross‐communications that likely exist in this region of the heart. John Wiley and Sons Inc. 2020-07-16 /pmc/articles/PMC7816812/ /pubmed/32672409 http://dx.doi.org/10.1111/anec.12772 Text en © 2020 The Authors. Annals of Noninvasive Electrocardiology published by Wiley Periodicals LLC This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. |
spellingShingle | Case Reports Nantsupawat, Teerapat Krishnappa, Darshan Benditt, David G. Sinus arrest: A rare observation during radiofrequency ablation along the coronary sinus roof |
title | Sinus arrest: A rare observation during radiofrequency ablation along the coronary sinus roof |
title_full | Sinus arrest: A rare observation during radiofrequency ablation along the coronary sinus roof |
title_fullStr | Sinus arrest: A rare observation during radiofrequency ablation along the coronary sinus roof |
title_full_unstemmed | Sinus arrest: A rare observation during radiofrequency ablation along the coronary sinus roof |
title_short | Sinus arrest: A rare observation during radiofrequency ablation along the coronary sinus roof |
title_sort | sinus arrest: a rare observation during radiofrequency ablation along the coronary sinus roof |
topic | Case Reports |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7816812/ https://www.ncbi.nlm.nih.gov/pubmed/32672409 http://dx.doi.org/10.1111/anec.12772 |
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