Cryoballoon cardioneuroablation: New electrophysiological insights

Heart Rhythm O2, Journal Year: 2024, Volume and Issue: 5(4), P. 209 - 216

Published: March 20, 2024

BackgroundCardioneuroablation(CNA) targeting ganglionated plexi has shown promise in treating vasovagal syncope. Only radiofrequency ablation been used to achieve this goal thus far.ObjectiveWe investigated the utility of cryo-balloon ablation(CBA) pulmonary veins as a potential simplified approach CNA.MethodsWe are reporting our observations autonomic modulation series 17 patients undergoing CBA for atrial fibrillation and early experience using PVs 3 with malignant vagal syncope.ResultsIn AF, sinus cycle length was recorded intra-procedurally after individual PVs. We demonstrated most pronounced shortening isolation right upper PV which ablated last. There reduced SNRT AV nodal ERP CBA. The elevation resting heart rate by 6-7 beats/minute following persisted during follow-up 12 months. performed recurrent syncope mediated arrest (n=2) block (n=1). In all patients, resulted marked length. During 178±43 days (134-219 days) CNA abolition pauses, bradycardia related symptoms patients.ConclusionCBA (most importantly PV) may be predictable anatomic refractory due and/or deserve systematic investigation tool perform CNA.

Language: Английский

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Ablation of Paroxysmal Atrial Fibrillation: between Present and Future

Reviews in Cardiovascular Medicine, Journal Year: 2024, Volume and Issue: 25(4), P. 140 - 140

Published: April 8, 2024

Pulmonary vein isolation (PVI) is the established cornerstone for atrial fibrillation (AF) ablation, indeed current guidelines recognize PVI as gold standard first-time AF regardless of if it paroxysmal or persistent. Since 1998 when Haïssaguerre pioneered ablation demonstrating a burden reduction after segmental pulmonary (PV) our approach to was superior in terms methodology and technology. This review aims describe how has evolved over last twenty years. We will focus on available techniques, mechanistic understanding genesis possibility tailored treatment AF, before concluding with future perspective.

Language: Английский

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Cardioneuroablation for carotid sinus syndrome mediated by complete atrioventricular block

Journal of Arrhythmia, Journal Year: 2023, Volume and Issue: 39(5), P. 810 - 812

Published: Aug. 23, 2023

Carotid sinus syndrome (CSS) is a rare condition leading to recurrent syncope. Permanent pacemaker implantation the mainstay treatment of cardioinhibitory CSS. In this report, we present CSS patient with reproducible atrioventricular block during carotid massage, who was treated cardioneuroablation.

Language: Английский

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Cardioneural ablation—the first case series without the use of fluoroscopy

Journal of Interventional Cardiac Electrophysiology, Journal Year: 2024, Volume and Issue: unknown

Published: Aug. 1, 2024

Language: Английский

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Photon-Scanning Approach to Control Spiral Wave Dynamics in the Heart

Physical Review Letters, Journal Year: 2024, Volume and Issue: 133(21)

Published: Nov. 20, 2024

Self-organizing spiral electrical waves are produced in the heart during fatal cardiac arrhythmias. Controlling these is therefore an essential step managing disease. Here we present effective method for controlling using optogenetics. The involves photons to actively scan surface of phase singularities. Once detected, singularities redirected inexcitable wall be eliminated. Thus, can controlled a double-blind fashion. We two theoretical mechanisms with ex vivo validation.

Language: Английский

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Differential and synergistic effects of right and left atrial ganglionated plexi ablation in patients undergoing cardioneuroablation: results from the ELEGANCE multicenter study

Journal of Interventional Cardiac Electrophysiology, Journal Year: 2024, Volume and Issue: unknown

Published: Dec. 13, 2024

Language: Английский

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Cardioneuroablation for the Treatment of Vasovagal Syncope: Current Status and Impact on Quality of Life

Current Cardiology Reports, Journal Year: 2023, Volume and Issue: 25(12), P. 1839 - 1849

Published: Nov. 20, 2023

Language: Английский

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Autonomic modulation: Getting it “just right”

Heart Rhythm O2, Journal Year: 2023, Volume and Issue: 4(6), P. 414 - 415

Published: May 11, 2023

The autonomic nervous system (ANS) is a dense, complex, interconnected, neurohumoral network with intertwined feedback that regulates all organ systems in plastic way under myriad of circumstances, generally to, and for, our advantage. Occasionally, the ANS appears to misbehave or, at least, acts inexplicably counter efficient functionality leading heart rates are too fast or slow. In this issue Heart Rhythm O2, Pachon colleagues,1Pachon J.C. E.I. Aksu T. et al.Cardioneuroablation: where we at?.Rhythm O2. 2023; 4: 401-413Abstract Full Text PDF Google Scholar creative pioneers leaders burgeoning field cardiac modulation, have contributed “Cardioneuroablation: Where We At?” They review use cardioneuroablation (CNA) treat recurrent vasovagal syncope (VVS) functional (autonomic) bradycardias without need for further therapy. their review, colleagues consider CNA select patients symptoms mediated by hypervagotonia. commend groundbreaking developments neuromodulation. level interest growing rapidly! Hypervagotonia, as disease entity, though, perplexing. High vagal tone, persistent intermittent, associated slower be good long-term prognosis.2Olshansky B, Ricci F, Fedorowski A. Importance resting rate. Trends Cardiovasc Med 2022 May 25 [E-pub ahead print].Google Scholar,3Gopinathannair R. Sullivan R.M. Olshansky B. Slower healthy hearts: time redefine tachycardia?.Circ Arrhythm Electrophysiol. 2008; 1: 321-323Crossref PubMed Scopus (9) Episodic intense discharge, itself, neither abnormal nor necessarily deleterious. Reasons episodic, apparent, overactivity often remain poorly understood; most part, no treatment needed. If episodes VVS occasional, eliminating connections seems overambitious, but there may value those multiple, severe, unprovoked symptomatic bradycardia due high activity. As therapy established these patients, worth considering. Observational data promising,1Pachon limited far from definitive. Eliminating halt transient long-lasting effects not safe now future. Destroying inputs when vagus working it should 99% time, misbehaves 1% raises concern. Persistently faster loss control, even if rate normal range, ensue. Long-term consequences emerge improve.2Olshansky part meta-analysis considered VVS, Vandenberk colleagues4Vandenberk Lei L.Y. Ballantyne al.Cardioneuroablation syncope: systematic meta-analysis.Heart Rhythm. 2022; 19: 1804-1812Abstract (13) reported results 11 studies (N = 337 patients) which adverse events were evaluated after CNA. Six events. However, 43 (12.8%) reports experienced including inappropriate sinus tachycardia procedural complications. These represent early outcomes. It remains unclear what, any, delayed transpire. exact procedure required obtain complete benefit little risk uncertain.5Brignole M, T, Calò L, al. Clinical controversy: methodology indications reflex syncope. Europace 2023 Apr 6 discuss dramatic benefits mostly small uncontrolled studies.4Vandenberk spontaneous remission has been shown repeatedly control arms studies. one report 51 mean 5.5 during median follow-up 15 months, 94% remained syncope-free.6Aksu Guler T.E. Bozyel S. Yalin K. Gopinathannair Usefulness post-procedural response predict recurrence positive head up tilt table testing cardioneuroablation.Europace. 2020; 22: 1320-1327Crossref (20) observational randomized 2.6 ± 1.0 spells per year lasting 7.1 years, 36% syncope-free diagnosis any whatsoever.7Pournazari P. Sahota I. Sheldon studies.J Am Coll Cardiol EP. 2017; 3: 384-392Google study follow undergoing vs conservative management over long term, similar degree (ie, regression another mechanism) present.8Olshansky Placebo nocebo cardiovascular health: implications healthcare, research, doctor-patient relationship.J Cardiol. 2007; 49: 415-421Crossref (63) Only controlled clinical trial investigated refractory VVS. This showed substantial decrease (54% arm 8% 2 years).9Piotrowski Baran J. Sikorska Krynski Kulakowski Cardioneuroablation efficacy on regulation - prospective trial.J 9: 85-95Google was unblinded sham arm. Unfortunately, few proper arms, followed durations. known pacemaker strong placebo implantation) can apparently affect outcomes also prominent therapies involving ANS.8Olshansky Scholar,10Connolly S.J. Thorpe K.E. al.Pacemaker prevention 23 severe Second Vasovagal Pacemaker Study (VPS II): trial.JAMA. 2003; 289: 2224-2229Crossref (443) Scholar,11Bhatt D.L. Kandzari D.E. O'Neill W.W. al.A renal denervation resistant hypertension.N Engl J Med. 2014; 370: 1393-1401Crossref (1650) Nevertheless, well-controlled trials indicated pacemakers VVS.12Gopinathannair R, Turagam MK, Permanent pacing versus cardioinhibitory Interv Card Electrophysiol Dec Scholar,13Baron-Esquivias G. Morillo C.A. Moya-Mitjans al.Dual-chamber closed loop stimulation SPAIN Study.J 70: 1710-1718Crossref (76) Yet, compared colleagues14Pachon J.C.M. E.I.M. Cunha M.Z. Lobo T.J. Santillana T.G.P. Catheter ablation neurally meditated (neurocardiogenic vasovagal) results.Europace. 2011; 13: 1231-1242Crossref (120) suggested younger would better treated than pacemakers. A 115 vasodepressor component, suggesting CNA, irrespective subgroup.15Hu F. Zheng L. Liang E. al.Right anterior ganglionated plexus: primary target cardioneuroablation?.Heart 2019; 16: 1545-1551Abstract (71) Due largely single-center studies, ideal candidate established. retrospective unpublished multicenter U.S. registry annual meeting.16Tung Results US Multicenter Cardioneural Ablation Registry. Presented at: Society Conference; April 29–May 1, San Francisco, CA.Google compelling selected, 9-month follow-up, design defining population, group, inconclusive. recently proposed Hybrid Epicardial Endocardial Sinus Node Sparing Therapy Inappropriate Tachycardia (HEAL-IST) investigational device exemption (IDE) (NCT05280093) sets an example cautious optimism regarding modulation.17De Asmundis C. Pannone Lakkireddy D. al.Hybrid epicardial endocardial node-sparing tachycardia: rationale HEAL-IST IDE trial.Heart 275-282Abstract (1) published De propose node–sparing approach IST. salute efforts providing groundwork view understand before completed. support publishing such advance welcome them Ideally, investigators do well publish designs conclusion so inclusion exclusion criteria comment design. encourage convincing, definitive, well-designed, multicenter, prospective, comparing valid defines carefully shows harm. With data, consensus who undergo what optimal standardized technique is, how evaluate effectiveness harm.5Brignole hope get just right circumstances—not slow sympathetic modulation IST, considering “The Story Three Bears.”18Southey story three bears.in: Doctor. 4. Longman, Rees, Orme, Brown, Green London, United Kingdom1837: 318-326Google When comes rate, enthusiastic, supportive, optimistic instead being right. still much work do. research did receive specific grant funding agencies public, commercial, not-for-profit sectors.

Language: Английский

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Left or right – where to in cardioneuroablation

Bulgarian Cardiology, Journal Year: 2024, Volume and Issue: 29(4), P. 7 - 9

Published: Jan. 9, 2024

Language: Английский

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State of the Journal 2024: Heart Rhythm O

Heart Rhythm O2, Journal Year: 2024, Volume and Issue: 5(1), P. 1 - 2

Published: Jan. 1, 2024

Greetings from Heart Rhythm O2 (HRO2). The Journal is starting its 5th year of publication, and we are looking forward to continued growth. As you know, have been publishing monthly now for the past year. Submissions continue be strong, with an acceptance rate 52%. majority articles published original research articles. 2 most frequently downloaded were a Design Paper, “A randomized controlled trial pulsed field ablation versus standard-of-care paroxysmal atrial fibrillation: ADVENT rationale design,” by Vivek Y.

Language: Английский

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