1
|
Aksu T, Brignole M, Calo L, Debruyne P, Di Biase L, Deharo JC, Fanciulli A, Fedorowski A, Kulakowski P, Morillo C, Moya A, Piotrowski R, Stec S, Sutton R, van Dijk JG, Wichterle D, Tse HF, Yao Y, Sheldon RS, Vaseghi M, Pachon JC, Scanavacca M, Meyer C, Amin R, Gupta D, Magnano M, Malik V, Schauerte P, Shen WK, Acosta JCZ. Cardioneuroablation for the treatment of reflex syncope and functional bradyarrhythmias: A Scientific Statement of the European Heart Rhythm Association (EHRA) of the ESC, the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS) and the Latin American Heart Rhythm Society (LAHRS). Europace 2024; 26:euae206. [PMID: 39082698 DOI: 10.1093/europace/euae206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2024] [Accepted: 07/18/2024] [Indexed: 08/29/2024] Open
Abstract
Cardioneuroablation has emerged as a potential alternative to cardiac pacing in selected cases with vasovagal reflex syncope, extrinsic vagally induced sinus bradycardia-arrest or atrioventricular block. The technique was first introduced decades ago, and its use has risen over the past decade. However, as with any intervention, proper patient selection and technique are a prerequisite for a safe and effective use of cardioneuroablation therapy. This document aims to review and interpret available scientific evidence and provide a summary position on the topic.
Collapse
Affiliation(s)
- Tolga Aksu
- Department of Cardiology, Yeditepe University Hospital, İçerenköy Mah. Hastahane Sok. 4,4/1 34752 Ataşehir/İstanbul, Turkey
| | - Michele Brignole
- Department of Cardiology, IRCCS Istituto Auxologico Italiano, Hospital S. Luca, Milan, Italy
| | - Leonardo Calo
- Department of Cardiology, Policlinico Casilino, Rome, Italy
| | | | - Luigi Di Biase
- Department of Cardiology, Albert Einstein College of Medicine, at Montefiore Hospital, New York, USA
| | - Jean Claude Deharo
- Hôpitaux de Marseille, Centre Hospitalier Universitaire La Timone, Service de Cardiologie, France and Aix Marseille Université, C2VN, 13005 Marseille, France
| | - Alessandra Fanciulli
- Department of Neurology, Medical University of Innsbruck, 6020 Innsbruck, Austria
| | - Artur Fedorowski
- Department of Cardiology, Karolinska University Hospital, Solna, Sweden
- Department of Medicine, Karolinska Institute, 171 76 Stockholm, Sweden
- Department of Clinical Sciences, Lund University, 202 13 Malmö, Sweden
| | - Piotr Kulakowski
- Centre of Postgraduate Medical Education, Department of Cardiology, Grochowski Hospital, 04-073 Warsaw, Poland
| | - Carlos Morillo
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, T2N 1N4 Calgary, AB, Canada
- Molecular Arrhythmias, Centro Nacional de Investigaciones Cardiovasculares (CNIC) Carlos III C. de Melchor Fernández Almagro, 3, 28029, Madrid, España
| | - Angel Moya
- Department of Cardiology, Hospital Universitari Dexeus, 08028 Barcelona, Spain
| | - Roman Piotrowski
- Centre of Postgraduate Medical Education, Department of Cardiology, Grochowski Hospital, 04-073 Warsaw, Poland
| | - Sebastian Stec
- Division of Electrophysiology, Cardioneuroablation, Catheter Ablation and Cardiac Stimulation, Subcarpathian Center for Cardiovascular Intervention, Sanok, Poland
| | - Richard Sutton
- Department of Cardiology, Hammersmith Hospital Campus, National Heart & Lung Institute, Imperial College, London, UK
| | - J Gert van Dijk
- Department of Neurology, Leiden University Medical Centre, Albinusdreef 2, Zuid Holland, 2333 ZA Leiden, The Netherlands
| | - Dan Wichterle
- Department of Cardiology, Institute for Clinical and Experimental Medicine (IKEM), 14021 Prague, Czechia
| | - Hung-Fat Tse
- Department of Medicine, The University of Hong Kong, Pokfulam, Hong Kong SAR
| | - Yan Yao
- Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
| | - Robert S Sheldon
- Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, T2N 1N4 Calgary, AB, Canada
| | - Marmar Vaseghi
- UCLA Cardiac Arrhythmia Center Division of Cardiology, Department of Medicine, University of California, Los Angeles, CA, USA
| | - Jose C Pachon
- Dante Pazzanese Cardiology Institute, São Paulo Heart Hospital, São Paulo University, São Paulo, Brazil
| | - Maurício Scanavacca
- Arrhythmia Unit-Heart Institute (Incor), University of São Paulo Medical School, Avenida Doutor Enéas Carvalho de Aguiar 44, São Paulo CEP 05403-000, SP, Brazil
| | - Christian Meyer
- Division of Cardiology/Angiology/Intensive Care, EVK Düsseldorf, Teaching Hospital, University of Düsseldorf, Kirchfeldstraße 40, 40217 Düsseldorf, Germany
| | - Reshma Amin
- Cardiovascular Department, Kings College Hospital NHS Foundation Trust, London, UK
| | - Dhiraj Gupta
- Department of Cardiology, Liverpool Heart and Chest Hospital, Faculty of Health and Life Sciences, University of Liverpool, Liverpool, UK
| | - Massimo Magnano
- Cardiology Department, Sant'Andrea Hospital, Vercelli, Italy
| | - Varun Malik
- Centre for heart Rhythm Disorders, University of Adelaide, Adelaide, Australia
| | - Patrick Schauerte
- Department of Cardiology, Herzmedizin-Berlin HMB MVZ GmbH, Rudower Chaussee 9, 12489 Berlin, Germany
- Interventionelle Kardiologie DGK, Herzinsuffizienz DGK, Germany
| | - Win-Kuang Shen
- Department of Cardiovascular Diseases, Mayo Clinic, Arizona, USA
- Department of Cardiology, Mayo Clinic College of Medicine, Rochester, MN, USA
| | | |
Collapse
|
2
|
Marrese A, Persico R, Parlato E, Faccenda D, Salucci A, Comparone G, Pergola V, Ammirati G, Addeo L, Fonderico C, Cocchiara L, Volpe A, Visconti P, Rapacciuolo A, Strisciuglio T. Cardioneuroablation: the known and the unknown. Front Cardiovasc Med 2024; 11:1412195. [PMID: 39131701 PMCID: PMC11310060 DOI: 10.3389/fcvm.2024.1412195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 06/28/2024] [Indexed: 08/13/2024] Open
Abstract
Cardioneuroablation (CNA) is a novel interventional procedure for the treatment of recurrent vasovagal syncope (VVS) and advanced atrioventricular block secondary to hyperactivation of vagal tone in young patients. By damaging the cardiac parasympathetic ganglia, CNA seems to be able to mitigate and/or abolish the excessive vagal activity and improve patients' outcome. This review is intended to give a detailed and comprehensive overview of the current evidences regarding (1) the clinical applications of CNA (2) the identification of ablation targets and procedural endpoints (3) the medium-long term effect of the procedure and its future perspectives. However, clinical data are still limited, and expert consensus or recommendations in the guidelines regarding this technique are still lacking.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - T. Strisciuglio
- Department of Cardiology, University of Naples Federico II, Naples, Italy
| |
Collapse
|
3
|
Aksu T, Piotrowski R, Tung R, De Potter T, Markman TM, du Fay de Lavallaz J, Rekvava R, Alyesh D, Joza JE, Badertscher P, Do DH, Bradfield JS, Upadhyay G, Sood N, Sharma PS, Guler TE, Gul EE, Kumar V, Koektuerk B, Dal Forno ARJ, Woods CE, Rav-Acha M, Valeriano C, Enriquez A, Sundaram S, Glikson M, d’Avila A, Shivkumar K, Kulakowski P, Huang HD. Procedural and Intermediate-term Results of the Electroanatomical-guided Cardioneuroablation for the Treatment of Supra-Hisian Second- or Advanced-degree Atrioventricular Block: the PIRECNA multicentre registry. Europace 2024; 26:euae164. [PMID: 38954426 PMCID: PMC11218561 DOI: 10.1093/europace/euae164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 04/18/2024] [Indexed: 07/04/2024] Open
Abstract
AIMS Prior case series showed promising results for cardioneuroablation in patients with vagally induced atrioventricular blocks (VAVBs). We aimed to examine the acute procedural characteristics and intermediate-term outcomes of electroanatomical-guided cardioneuroablation (EACNA) in patients with VAVB. METHODS AND RESULTS This international multicentre retrospective registry included data collected from 20 centres. Patients presenting with symptomatic paroxysmal or persistent VAVB were included in the study. All patients underwent EACNA. Procedural success was defined by the acute reversal of atrioventricular blocks (AVBs) and complete abolition of atropine response. The primary outcome was occurrence of syncope and daytime second- or advanced-degree AVB on serial prolonged electrocardiogram monitoring during follow-up. A total of 130 patients underwent EACNA. Acute procedural success was achieved in 96.2% of the cases. During a median follow-up of 300 days (150, 496), the primary outcome occurred in 17/125 (14%) cases with acute procedural success (recurrence of AVB in 9 and new syncope in 8 cases). Operator experience and use of extracardiac vagal stimulation were similar for patients with and without primary outcomes. A history of atrial fibrillation, hypertension, and coronary artery disease was associated with a higher primary outcome occurrence. Only four patients with primary outcome required pacemaker placement during follow-up. CONCLUSION This is the largest multicentre study demonstrating the feasibility of EACNA with encouraging intermediate-term outcomes in selected patients with VAVB. Studies investigating the effect on burden of daytime symptoms caused by the AVB are required to confirm these findings.
Collapse
Affiliation(s)
- Tolga Aksu
- Department of Cardiology, Yeditepe University Hospital, Icerenkoy Mah. Hastahane Sok. 4, 34752, Istanbul, Turkey
| | - Roman Piotrowski
- Centre of Postgraduate Medical Education, Department of Cardiology, Grochowski Hospital, 01-809, Warsaw, Poland
| | - Roderick Tung
- The University of Arizona College of Medicine-Phoenix, Department of Cardiology, Banner University Medical Center, Phoenix, AZ 85004, USA
| | - Tom De Potter
- Cardiovascular Center, OLV Hospital, Aalst, 9300, Belgium
| | - Timothy M Markman
- Division of Cardiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
| | | | - Roin Rekvava
- Department of Rhythm Management and Electrophysiology, American Hospital Tbilisi, Tbilisi 01102, Georgia
| | - Daniel Alyesh
- South Denver Cardiology Associates, Littleton, CO 80120, USA
| | - Jacqueline E Joza
- Department of Cardiology, McGill University, Montreal, QC, H3A 0G4, Canada
| | - Patrick Badertscher
- Department of Cardiology, University Hospital Basel, Petersgraben 4, 4031 Basel, Switzerland
| | - Duc H Do
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
| | - Jason S Bradfield
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
| | - Gaurav Upadhyay
- Section of Cardiology, Center for Arrhythmia Care, University of Chicago Medicine, Chicago, IL 60637, USA
| | - Nitesh Sood
- Department of Cardiology, Southcoast Health, Fall River, MA 02720, USA
| | - Parikshit S Sharma
- Division of Cardiology, Rush University Medical Center, 1717 West Congress Parkway, Chicago, IL 60612, USA
| | - Tumer Erdem Guler
- Division of Cardiology, Kocaeli State Hospital, Kocaeli, 41060, Turkey
| | - Enes Elvin Gul
- Division of Cardiology, Atlas University, Medicine Hospital, Istanbul, 34203, Turkey
| | - Vineet Kumar
- Inova Medical Group, Arrhythmia 8081 Innovation Park Dr 602, Fairfax, VA 22031, USA
| | - Buelent Koektuerk
- Department of Cardiology, Witten/Herdecke University, Witten, D-58455, Germany
- Department of Cardiology and Electrophysiology, Sana Clinics Düsseldorf, Düsseldorf, 40625, Germany
| | | | - Christopher E Woods
- Department of Cardiology, California Pacific Medical Center, San Francisco, CA 94110, USA
| | - Moshe Rav-Acha
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Hebrew University Faculty of Medicine, PO Box 3235, Jerusalem 9103102, Israel
| | | | - Andres Enriquez
- Division of Cardiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104, USA
- Division of Cardiology, Queen’s University, Kingston, ON K7l 3N6, Canada
| | - Sri Sundaram
- South Denver Cardiology Associates, Littleton, CO 80120, USA
| | - Michael Glikson
- Jesselson Integrated Heart Center, Shaare Zedek Medical Center and Hebrew University Faculty of Medicine, PO Box 3235, Jerusalem 9103102, Israel
| | - Andre d’Avila
- Beth Israel Deaconess Medical Center, Harvard Thorndike Electrophysiology Institute, Boston, MA 02215, USA
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center, Ronald Reagan UCLA Medical Center, 100 Medical Plaza, Suite 660, Los Angeles, CA 90095, USA
| | - Piotr Kulakowski
- Centre of Postgraduate Medical Education, Department of Cardiology, Grochowski Hospital, 01-809, Warsaw, Poland
| | - Henry D Huang
- Division of Cardiology, Rush University Medical Center, 1717 West Congress Parkway, Chicago, IL 60612, USA
| |
Collapse
|
4
|
Lam KHS, Su DCJ, Wu YT, Varrassi G, Suryadi T, Reeves KD. A Novel Ultrasound-Guided Bilateral Vagal Nerve Hydrodissection With 5% Dextrose Without Local Anesthetic for Recalcitrant Chronic Multisite Pain and Autonomic Dysfunction. Cureus 2024; 16:e63609. [PMID: 38957517 PMCID: PMC11218924 DOI: 10.7759/cureus.63609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2024] [Accepted: 06/30/2024] [Indexed: 07/04/2024] Open
Abstract
Chronic pain is a complex condition that often poses diagnostic and management challenges due to its multifactorial etiology. This case report describes a 49-year-old pastor who presented with a three-year history of chronic pain affecting multiple sites, including the neck, bilateral shoulders, thoracic region, lower back, and bilateral knees. Additionally, he experienced shortness of breath on mild exertion, which adversely affected his ability to converse and speak publicly. The patient had a rapid resting heart rate of 100-120 beats per minute, occasional palpitations, and a 24-hour electrocardiogram that confirmed 15% premature ventricular complexes with bigeminy and trigeminy. He complained of limited appetite with early satiety, intermittent nausea, and regurgitation. Despite consultations with multiple specialists, no underlying causes were identified in the cardiac, respiratory, gastrointestinal, or psychological domains. Ultrasound-guided bilateral vagus nerve hydrodissection using 5% dextrose without local anesthetics was administered three times at monthly intervals, resulting in remarkable pain relief within three months and the effects persisted at the nine-month follow-up. Tachycardia was no longer perceived, resting heart rate slowed to 70-80 beats per minute, shortness of breath improved, and public speaking ability was restored. The patient's early satiety, nausea, and reflux complaints were resolved. This case report highlights the potential effectiveness of this novel intervention for chronic pain. Further research is warranted to validate these findings and explore the mechanism of action.
Collapse
Affiliation(s)
- King Hei Stanley Lam
- Board of Clinical Research, The Hong Kong Institute of Musculoskeletal Medicine, Kowloon, HKG
- Faculty of Medicine, The Chinese University of Hong Kong, New Territories, HKG
- Faculty of Medicine, The University of Hong Kong, Hong Kong, HKG
| | | | - Yung-Tsan Wu
- Physical Medicine and Rehabilitation, Tri-Service General Hospital, Taipei, TWN
| | | | - Teinny Suryadi
- Physical Medicine and Rehabilitation, Synergy Clinic, Jakarta, IDN
- Physical Medicine and Rehabilitation, Hermina Podomoro Hospital, Jakarta, IDN
| | - K Dean Reeves
- Rehabilitation Medicine, Private Practice, Kansas City, USA
| |
Collapse
|
5
|
Stec S, Wileczek A, Reichert A, Śledź J, Kosior J, Jagielski D, Polewczyk A, Zając M, Kutarski A, Karbarz D, Zyśko D, Nowarski Ł, Stodółkiewicz-Nowarska E. Shared Decision Making and Cardioneuroablation Allow Discontinuation of Permanent Pacing in Patients with Vagally Mediated Bradycardia. J Cardiovasc Dev Dis 2023; 10:392. [PMID: 37754821 PMCID: PMC10532162 DOI: 10.3390/jcdd10090392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Revised: 08/24/2023] [Accepted: 08/31/2023] [Indexed: 09/28/2023] Open
Abstract
BACKGROUND Safe discontinuation of pacemaker therapy for vagally mediated bradycardia is a dilemma. The aim of the study was to present the outcomes of a proposed diagnostic and therapeutic process aimed at discontinuing or not restoring pacemaker therapy (PPM) in patients with vagally mediated bradycardia. METHODS The study group consisted of two subgroups of patients with suspected vagally mediated bradycardia who were considered to have PPM discontinued or not to restore their PPM if cardioneuroablation (CNA) would successfully treat their bradycardia. A group of 3 patients had just their pacemaker explanted but reimplantation was suggested, and 17 patients had preexisting pacemakers implanted. An invasive electrophysiology study was performed. If EPS was negative, extracardiac vagal nerve stimulation (ECVS) was performed. Then, patients with positive ECVS received CNA. Patients with an implanted pacemaker had it programmed to pace at the lowest possible rate. After the observational period and control EPS including ECVS, redo-CNA was performed if pauses were induced. The decision to explant the pacemaker was obtained based on shared decision making (SDM). RESULTS After initial clinical and electrophysiological evaluation, 17 patients were deemed eligible for CNA (which was then performed). During the observational period after the initial CNA, all 17 patients were clinically asymptomatic. The subsequent invasive evaluation with ECVS resulted in pause induction in seven (41%) patients, and these patients underwent redo-CNA. Then, SDM resulted in the discontinuation of pacemaker therapy or a decision to not perform pacemaker reimplantation in all the patients after CAN. The pacemaker was explanted in 12 patients post-CNA, while in 2 patients explantation was postponed. During a median follow-up of 18 (IQR: 8-22) months, recurrent syncope did not occur in the CNA recipients. CONCLUSIONS Pacemaker therapy in patients with vagally mediated bradycardia could be discontinued safely after CNA.
Collapse
Affiliation(s)
- Sebastian Stec
- Division of Electrophysiology, Cardioneuroablation, Catheter Ablation and Cardiac Stimulation, Subcarpathian Center for Cardiovascular Intervention, 38-500 Sanok, Poland
| | - Antoni Wileczek
- Division of Electrophysiology, Cardioneuroablation, Catheter Ablation and Cardiac Stimulation, Subcarpathian Center for Cardiovascular Intervention, 38-500 Sanok, Poland
| | - Agnieszka Reichert
- Department of Invasive Cardiology, County Specialistic Hospital, 37-450 Stalowa Wola, Poland
| | - Janusz Śledź
- El-Medica, EP-NETWORK, 26-110 Skarzysko-Kamienna, Poland
| | - Jarosław Kosior
- Department of Cardiology, Masovian Specialist Hospital, 26-617 Radom, Poland
| | - Dariusz Jagielski
- Department of Cardiology, Centre for Heart Diseases, 4th Military Hospital, 50-981 Wroclaw, Poland
- Faculty of Medicine, Wrocław University of Science and Technology, 50-370 Wroclaw, Poland
| | - Anna Polewczyk
- Department of Physiology, Pathophysiology and Clinical Immunology, Institute of Medical Sciences, Jan Kochanowski University, 25-369 Kielce, Poland
- Department of Cardiac Surgery, Świętokrzyskie Center of Cardiology, 25-736 Kielce, Poland
| | - Magdalena Zając
- Department of Special Pedagogy and Speech Therapy, Kazimierz Wielki University, 85-064 Bydgoszcz, Poland
| | - Andrzej Kutarski
- Department of Cardiology, Medical University, 20-059 Lublin, Poland
| | | | - Dorota Zyśko
- Department of Emergency Medicine, Wrocław Medical University, 50-367 Wroclaw, Poland
| | - Łukasz Nowarski
- Vascular Surgery Department, The Brothers of Saint John of God Hospital, 31-061 Krakow, Poland
| | | |
Collapse
|
6
|
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
| | | |
Collapse
|
7
|
Abstract
INTRODUCTION Cardioneuroablation is increasingly being utilized to improve outcomes in patients with vagally mediated bradyarrhythmias. However, there are still controversial issues in the field including patient selection, safety and efficacy, and procedural end-points. AREAS COVERED In this review, the current role of cardioneuroablation is summarized, and controversial issues related to the modality are discussed. EXPERT OPINION According to small open-label cohort studies, overall freedom from syncope recurrence was higher than 90% after cardioneuroablation in patients with vasovagal syncope (VVS). Use of the electrogram-based strategy or high-frequency stimulation demonstrate similar success rate except in procedures limited to the right atrium. Based on a recently published randomized controlled trial and metanalysis, it may be possible now to make a strong recommendation for cardioneuroablation in patients <40 years of age, and those with the cardioinhibitory or mixed type of VVS who continue to experience frequent and/or burdensome syncope recurrences. Considering patients with VVS are prone to significant placebo/expectation effect, sham-controlled trials may help to quantify the placebo effect. In well-selected patients with functional atrioventricular block and sinus bradycardia, may result in encouraging medium-term outcomes. However, functional bradycardia is identified in a minority of patients presenting with high-grade atrioventricular block or sinus node dysfunction.
Collapse
Affiliation(s)
- Tolga Aksu
- Department of Cardiology, Yeditepe University Hospital, Istanbul, Turkey
| | - Asad Khan
- Department of Cardiology, Rush Medical College, Chicago, IL, USA
| | - Henry Huang
- Department of Cardiology, Rush Medical College, Chicago, IL, USA
| |
Collapse
|
8
|
Ultrasound-guided extra-cardiac vagal stimulation – new approach for visualization of vagus nerve during cardioneuroablation. Heart Rhythm 2022; 19:1247-1252. [DOI: 10.1016/j.hrthm.2022.04.014] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 03/31/2022] [Accepted: 04/16/2022] [Indexed: 11/21/2022]
|
9
|
The "heart brain" and neuromodulation for vasovagal syncope. Auton Neurosci 2021; 236:102892. [PMID: 34666205 DOI: 10.1016/j.autneu.2021.102892] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Revised: 09/02/2021] [Accepted: 09/29/2021] [Indexed: 11/22/2022]
Abstract
It is well known that the autonomic nervous system (ANS) is a major contributor in etiopathogenesis of vasovagal syncope (VVS). Catheter based neuromodulation (CNA) of the intrinsic cardiac ANS has evolved rapidly from being an experimental unproven procedure to its current status as an increasingly performed ablation procedure in many major hospitals worldwide. The present review aims to bring the anatomical elements of intrinsic cardiac ANS and clinical application of intrinsic cardiac neuromodulation together, by reviewing anatomical terminologies and clinical data, in order to provide a practical assistance to the electrophysiology community.
Collapse
|