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Kulakowski P, Baran J, Sikorska A, Krynski T, Niedzwiedz M, Soszynska M, Piotrowski R. Cardioneuroablation for reflex asystolic syncope: Mid-term safety, efficacy, and patient's acceptance. Heart Rhythm 2024; 21:282-291. [PMID: 38036236 DOI: 10.1016/j.hrthm.2023.11.022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 11/19/2023] [Accepted: 11/25/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND Cardioneuroablation (CNA) is a promising therapy for reflex asystolic syncope; however, convincing data on the mid-term safety and efficacy of this procedure are lacking. OBJECTIVE The purpose of this study was to assess the mid-term safety, efficacy, and patient acceptance of CNA. METHODS This prospective observational single-center study included 115 consecutive patients (mean age 39 ± 13 years; 58% female) treated between 2016 and 2022 who completed at least 1-year follow-up. RESULTS No significant procedure-related acute complications occurred. During median follow-up of 28 months (range 12-75), 95 (83%) remained free from syncope. Of the 20 patients (17%) with syncope recurrence, syncope burden decreased from a mean 17 (median 6.5) to 3.75 (median 2.5) episodes (P = .015). In 9 of 10 patients, pacing system removal was possible. Repeated CNA was needed in 3 patients (3%), whereas pacemaker implantation was performed in 5 (4%). The most frequent mid-term complication of CNA was sinus rhythm acceleration (from 60 ± 14 bpm to 90 ± 16 bpm; P <.0001), which was symptomatic in 31 patients (27%); 8 patients (7%) required chronic beta-blocker and/or ivabradine. Sinus node modification was necessary in 1 patient. Other complaints included dyspnea, chronic chest pain, and decreased exercise capacity, which were mild and reported by 16 patients (14%). Patient acceptance of CNA was very high: 96% stated that it was worth undergoing the procedure. CONCLUSIONS Mid-term efficacy of CNA exceeds 80%, and acute complications are absent. The most frequent mid-term chronic complication is inappropriate sinus tachycardia, which in 7% required chronic treatment. The procedure is well accepted by patients.
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Affiliation(s)
- Piotr Kulakowski
- Centre of Postgraduate Medical Education, Department of Cardiology, Grochowski Hospital, Warsaw, Poland
| | - Jakub Baran
- Centre of Postgraduate Medical Education, Department of Cardiology, Grochowski Hospital, Warsaw, Poland
| | - Agnieszka Sikorska
- Centre of Postgraduate Medical Education, Department of Cardiology, Grochowski Hospital, Warsaw, Poland
| | - Tomasz Krynski
- Centre of Postgraduate Medical Education, Department of Cardiology, Grochowski Hospital, Warsaw, Poland
| | - Michal Niedzwiedz
- Centre of Postgraduate Medical Education, Department of Cardiology, Grochowski Hospital, Warsaw, Poland
| | - Malgorzata Soszynska
- Centre of Postgraduate Medical Education, Department of Cardiology, Grochowski Hospital, Warsaw, Poland
| | - Roman Piotrowski
- Centre of Postgraduate Medical Education, Department of Cardiology, Grochowski Hospital, Warsaw, Poland.
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Stec S, Jankowska-Polańska B, Jagielski D, Wileczek A, Josiak K, Śledź J, Reichert A, Kustroń A, Zyśko D, Skonieczny B, Fedorowski A, Ratajska A, Zając M, Hering D, Wąsek W, Stodółkiewicz-Nowarska E. Rationale and design of SAN.OK randomized clinical trial and registry: Comparison of the effects of evidence-based pacemaker therapy and cardioneuroablation in sinus node dysfunction. Cardiol J 2022; 29:1031-1036. [PMID: 36385604 PMCID: PMC9788751 DOI: 10.5603/cj.a2022.0103] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2022] [Revised: 10/10/2022] [Accepted: 10/31/2022] [Indexed: 11/19/2022] Open
Affiliation(s)
- Sebastian Stec
- Division of Electrophysiology, Cardioneuroablation, Catheter Ablation and Cardiac Stimulation, Subcarpathian Center for Cardiovascular Intervention, Sanok, Poland,Elmedica, EP-Network, SKA, Poland
| | | | - Dariusz Jagielski
- Department of Cardiology, Center for Heart Diseases, 4th Military Hospital, Wroclaw, Poland
| | - Antoni Wileczek
- Division of Electrophysiology, Cardioneuroablation, Catheter Ablation and Cardiac Stimulation, Subcarpathian Center for Cardiovascular Intervention, Sanok, Poland,Elmedica, EP-Network, SKA, Poland
| | - Krystian Josiak
- Department of Cardiology, Center for Heart Diseases, 4th Military Hospital, Wroclaw, Poland,Institute of Heart Diseases, Wroclaw Medical University, Wroclaw, Poland
| | | | | | | | - Dorota Zyśko
- Department of Cardiology, Center for Heart Diseases, 4th Military Hospital, Wroclaw, Poland,Department of Emergency Medicine, Wroclaw Medical University, Wroclaw, Poland
| | - Bartosz Skonieczny
- Department of Cardiology, Center for Heart Diseases, 4th Military Hospital, Wroclaw, Poland
| | - Artur Fedorowski
- Department of Cardiology, Karolinska University Hospital, Department of Medicine, Karolinska Institute, Stockholm, Sweden
| | - Anna Ratajska
- Psychological Therapeutic and Research Center, University Hospital No. 2, Bydgoszcz, Poland,Department of Humanization, Medicine and Sexology, Institute of Health Sciences, University of Zielona Gora, Poland
| | - Magdalena Zając
- Department of Pedagogy, University of Kazimierz Wielki, Bydgoszcz, Poland
| | - Dagmara Hering
- Department of Hyper tension and Diabetology, Medical University of Gdansk, Poland
| | - Wojciech Wąsek
- Department of Internal Medicine, Institute of Health Sciences, College of Medical Sciences, Rzeszow University, Poland
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Wileczek A, Polewczyk A, Kluk M, Kutarski A, Stec S. Ultrasound-guided imaging for vagus nerve stimulation to facilitate cardioneuroablation for the treatment of functional advanced atrioventricular block. Indian Pacing Electrophysiol J 2021; 21:403-406. [PMID: 34186197 PMCID: PMC8577098 DOI: 10.1016/j.ipej.2021.06.008] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Revised: 06/16/2021] [Accepted: 06/22/2021] [Indexed: 11/30/2022] Open
Abstract
We present a case study article demonstrating successful implementation of ultrasound guided extra cardiac vagus nerve stimulation during cardioneuroablation. To our knowledge it is first published description of this technique, as most ECVS are done in the internal jugular vein bulb area. This method allows for reduction of fluoroscopy time, and most importantly reproducible vagus nerve capture especially after full bi-nodal (sinus and atrioventricular) cardioneuroablation when stimulation of vagus nerve may not give any effect in the heart. This article includes a case study with “dual component” atrioventricular block, where functional component is cured with cardioneuroablation, but structural (PR elongation) remains after procedure.
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Affiliation(s)
- Antoni Wileczek
- Division of Electrophysiology, Cardioneuroablation, Catheter Ablation and Cardiac Stimulation, Subcarpathian Centre for Cardiovascular Intervention, 26 800-lecia st, Sanok, 38-500, Poland.
| | - Anna Polewczyk
- Department of Physiology, Pathophysiology and Clinical Immunology, Collegium Medicum, The Jan Kochanowski University in Kielce, IX Wieków Kielc 19A Alley, 25-317, Kielce, Poland; Department of Cardiac Surgery, Swietokrzyskie Cardiology Center in Kielce, Grunwaldzka 45 St., 25-736, Kielce, Poland
| | - Maciej Kluk
- Department of Interventional Cardiology, Swietokrzyskie Cardiology Center in Kielce, Grunwaldzka 45 St., 25-736, Kielce, Poland
| | - Andrzej Kutarski
- Department of Cardiology Medical University of Lublin, Jaczewskiego 4 St., 20-090, Lublin, Poland
| | - Sebastian Stec
- Division of Electrophysiology, Cardioneuroablation, Catheter Ablation and Cardiac Stimulation, Subcarpathian Centre for Cardiovascular Intervention, 26 800-lecia st, Sanok, 38-500, Poland
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