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Extracardiac Vagal Stimulation-Assisted Cardioneuroablation: Dynamically Evaluating the Impact of Sequential Ganglionated Plexus Ablation on Vagal Control of SAN and AVN in Patients with Sinoatrial Node Dysfunction

Cardioneuroablation (CNA) is proposed as a promising therapy for patients with sinoatrial node dysfunction (SND) that is mediated by excessive vagal tone. However, a series of urgent questions about CNA remain unanswered. From December 2020 to March 2022, six patients with symptomatic SND who underw...

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Autores principales: Chen, Weijie, Liu, Zengzhang, Xiao, Peilin, Xu, Yanping, Li, Dan, Xiong, Qingsong, Zou, Lili, Qin, Fang, Tao, Xiexin, Chen, Junan, Lan, Xianbin, Du, Huaan, Yin, Yuehui, Ling, Zhiyu
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2022
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9225033/
https://www.ncbi.nlm.nih.gov/pubmed/35735817
http://dx.doi.org/10.3390/jcdd9060188
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author Chen, Weijie
Liu, Zengzhang
Xiao, Peilin
Xu, Yanping
Li, Dan
Xiong, Qingsong
Zou, Lili
Qin, Fang
Tao, Xiexin
Chen, Junan
Lan, Xianbin
Du, Huaan
Yin, Yuehui
Ling, Zhiyu
author_facet Chen, Weijie
Liu, Zengzhang
Xiao, Peilin
Xu, Yanping
Li, Dan
Xiong, Qingsong
Zou, Lili
Qin, Fang
Tao, Xiexin
Chen, Junan
Lan, Xianbin
Du, Huaan
Yin, Yuehui
Ling, Zhiyu
author_sort Chen, Weijie
collection PubMed
description Cardioneuroablation (CNA) is proposed as a promising therapy for patients with sinoatrial node dysfunction (SND) that is mediated by excessive vagal tone. However, a series of urgent questions about CNA remain unanswered. From December 2020 to March 2022, six patients with symptomatic SND who underwent CNA were summarized in this report. Sequential CNA targeting Ao-SVC GP, PMLGP, RAGP, and LSGP was performed in patients, guided by fractionated intracardiac electrograms and dynamically evaluated by extracardiac vagal stimulation (ECVS). The results showed that Ao-SVC GP ablation led to a significant increase in heart rate (HR) and the elimination of sinus arrest evoked by ECVS, while the vagal responses of atrial ventricular block were eliminated by the ablation of PMLGP and LSGP. Post-procedure HR increased up to 64–86% of the maximum HR of an atropine test at baseline. The median HR from Holter monitoring increased from 52.8 ± 2.1 bpm at baseline to 73.0 ± 10.4 bpm after the procedure (p = 0.012) and to 71.3 ± 10.1 bpm at the six-month follow-up (p = 0.011). Bradycardia-related symptoms disappeared in all patients at the six-month follow-up. This case series reveals the feasibility of using the ECVS-assisted sequential CNA technique and indicates the critical role of ECVS in dynamically evaluating the impact of sequential CNA on the vagal control of SAN and AVN.
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spelling pubmed-92250332022-06-24 Extracardiac Vagal Stimulation-Assisted Cardioneuroablation: Dynamically Evaluating the Impact of Sequential Ganglionated Plexus Ablation on Vagal Control of SAN and AVN in Patients with Sinoatrial Node Dysfunction Chen, Weijie Liu, Zengzhang Xiao, Peilin Xu, Yanping Li, Dan Xiong, Qingsong Zou, Lili Qin, Fang Tao, Xiexin Chen, Junan Lan, Xianbin Du, Huaan Yin, Yuehui Ling, Zhiyu J Cardiovasc Dev Dis Article Cardioneuroablation (CNA) is proposed as a promising therapy for patients with sinoatrial node dysfunction (SND) that is mediated by excessive vagal tone. However, a series of urgent questions about CNA remain unanswered. From December 2020 to March 2022, six patients with symptomatic SND who underwent CNA were summarized in this report. Sequential CNA targeting Ao-SVC GP, PMLGP, RAGP, and LSGP was performed in patients, guided by fractionated intracardiac electrograms and dynamically evaluated by extracardiac vagal stimulation (ECVS). The results showed that Ao-SVC GP ablation led to a significant increase in heart rate (HR) and the elimination of sinus arrest evoked by ECVS, while the vagal responses of atrial ventricular block were eliminated by the ablation of PMLGP and LSGP. Post-procedure HR increased up to 64–86% of the maximum HR of an atropine test at baseline. The median HR from Holter monitoring increased from 52.8 ± 2.1 bpm at baseline to 73.0 ± 10.4 bpm after the procedure (p = 0.012) and to 71.3 ± 10.1 bpm at the six-month follow-up (p = 0.011). Bradycardia-related symptoms disappeared in all patients at the six-month follow-up. This case series reveals the feasibility of using the ECVS-assisted sequential CNA technique and indicates the critical role of ECVS in dynamically evaluating the impact of sequential CNA on the vagal control of SAN and AVN. MDPI 2022-06-10 /pmc/articles/PMC9225033/ /pubmed/35735817 http://dx.doi.org/10.3390/jcdd9060188 Text en © 2022 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Chen, Weijie
Liu, Zengzhang
Xiao, Peilin
Xu, Yanping
Li, Dan
Xiong, Qingsong
Zou, Lili
Qin, Fang
Tao, Xiexin
Chen, Junan
Lan, Xianbin
Du, Huaan
Yin, Yuehui
Ling, Zhiyu
Extracardiac Vagal Stimulation-Assisted Cardioneuroablation: Dynamically Evaluating the Impact of Sequential Ganglionated Plexus Ablation on Vagal Control of SAN and AVN in Patients with Sinoatrial Node Dysfunction
title Extracardiac Vagal Stimulation-Assisted Cardioneuroablation: Dynamically Evaluating the Impact of Sequential Ganglionated Plexus Ablation on Vagal Control of SAN and AVN in Patients with Sinoatrial Node Dysfunction
title_full Extracardiac Vagal Stimulation-Assisted Cardioneuroablation: Dynamically Evaluating the Impact of Sequential Ganglionated Plexus Ablation on Vagal Control of SAN and AVN in Patients with Sinoatrial Node Dysfunction
title_fullStr Extracardiac Vagal Stimulation-Assisted Cardioneuroablation: Dynamically Evaluating the Impact of Sequential Ganglionated Plexus Ablation on Vagal Control of SAN and AVN in Patients with Sinoatrial Node Dysfunction
title_full_unstemmed Extracardiac Vagal Stimulation-Assisted Cardioneuroablation: Dynamically Evaluating the Impact of Sequential Ganglionated Plexus Ablation on Vagal Control of SAN and AVN in Patients with Sinoatrial Node Dysfunction
title_short Extracardiac Vagal Stimulation-Assisted Cardioneuroablation: Dynamically Evaluating the Impact of Sequential Ganglionated Plexus Ablation on Vagal Control of SAN and AVN in Patients with Sinoatrial Node Dysfunction
title_sort extracardiac vagal stimulation-assisted cardioneuroablation: dynamically evaluating the impact of sequential ganglionated plexus ablation on vagal control of san and avn in patients with sinoatrial node dysfunction
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9225033/
https://www.ncbi.nlm.nih.gov/pubmed/35735817
http://dx.doi.org/10.3390/jcdd9060188
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