Long-Term Outcomes of Cardioneuroablation with and without Extra-Cardiac Vagal Stimulation Confirmation in Severe Cardioinhibitory Neurocardiogenic Syncope DOI Open Access
José Carlos Pachón-M,

Enrique Indalecio Pachon,

Carlos Thiene Cunha Pachón

et al.

Authorea (Authorea), Journal Year: 2023, Volume and Issue: unknown

Published: Oct. 9, 2023

Background Cardioneuroablation (CNA) is a novel therapeutic approach for functional bradyarrhythmias, specifically neurocardiogenic syncope or atrial fibrillation, achieved through endocardial radiofrequency catheter ablation of vagal innervation, obviating the need pacemaker implantation. Originating in nineties, first series CNA procedures was published 2005. Extra-cardiac stimulation (ECVS) employed as direct method stepwise denervation control during CNA. Objective This study aimed to compare long-term follow-up outcomes patients with severe cardioinhibitory undergoing and without confirmation via ECVS. Method A cohort 48 patients, predominantly female (56.3%), suffering from recurrent (5.1±2.5 episodes annually) that remained unresponsive clinical pharmacological interventions, underwent CNA, divided into two groups: ECVS NoECVS, consisting 34 14 cases, respectively. were conducted pacing. Results Demographic characteristics, left size, ejection fraction displayed no statistically significant differences between groups. Follow-up duration comparable, 29.1 ± 15 months group 31.9±20 NoECVS (p=0.24). Notably, recurrence significantly lower (2 cases vs. 4 Log Rank p=0.04). Moreover, Hazard ratio revealed five-fold higher risk group. Conclusion demonstrates concluding yields success rate substantially reduced compared confirmation.

Language: Английский

Neuroimaging Studies of the Neural Correlates of Heart Rate Variability: A Systematic Review DOI Open Access
Patrycja S. Matusik, Chuwen Zhong, Paweł T. Matusik

et al.

Journal of Clinical Medicine, Journal Year: 2023, Volume and Issue: 12(3), P. 1016 - 1016

Published: Jan. 28, 2023

Direct and indirect links between brain regions cardiac function have been reported. We performed a systematic literature review to summarize current knowledge regarding the associations of heart rate variability (HRV) region morphology, activity connectivity involved in autonomic control at rest healthy subjects. Both positive negative correlations cortical thickness gray matter volumes structures with HRV were observed. The strongest found for cluster located within cingulate cortex. A decline HRV, as well increasing age, especially orbitofrontal cortex noted. When region-specific examined, correlated most strongly insula, cortex, frontal prefrontal cortices, hippocampus, thalamus, striatum amygdala. Furthermore, significant correlations, largely positive, (in amygdala, cortex) Notably, right-sided neural may be preferentially control. However, evidence left hemispheric vagal has also Our findings provide support premise that are interconnected by both structural functional networks indicate complex multi-level interactions. Further studies brain-heart promise yield insights into their relationship health disease.

Language: Английский

Citations

28
Long‐term outcomes of cardioneuroablation with and without extra‐cardiac vagal stimulation confirmation in severe cardioinhibitory neurocardiogenic syncope DOI
José Carlos Pachón-M, Enrique Indalécio Pachón Mateos, Carlos Thiene Cunha Pachón

et al.

Journal of Cardiovascular Electrophysiology, Journal Year: 2024, Volume and Issue: 35(4), P. 641 - 650

Published: Jan. 19, 2024

Abstract Background Cardioneuroablation (CNA) is a novel therapeutic approach for functional bradyarrhythmias, specifically neurocardiogenic syncope or atrial fibrillation, achieved through endocardial radiofrequency catheter ablation of vagal innervation, obviating the need pacemaker implantation. Originating in nineties, first series CNA procedures was published 2005. Extra‐cardiac stimulation (ECVS) employed as direct method stepwise denervation control during CNA. Objective This study aimed to compare long‐term follow‐up outcomes patients with severe cardioinhibitory undergoing and without confirmation via ECVS. Method A cohort 48 patients, predominantly female (56.3%), suffering from recurrent (5.1 ± 2.5 episodes annually) that remained unresponsive clinical pharmacological interventions, underwent CNA, divided into two groups: ECVS NoECVS, consisting 34 14 cases, respectively. were conducted pacing. Results Demographic characteristics, left size, ejection fraction displayed no statistically significant differences between groups. Follow‐up duration comparable, 29.1 15 months group 31.9 20 NoECVS ( p = .24). Notably, recurrence significantly lower (two cases vs. four Log Rank .04). Moreover, Hazard ratio revealed fivefold higher risk group. Conclusion demonstrates concluding yields success rate substantially reduced compared confirmation.

Language: Английский

Citations

14
Selection of patients with symptomatic vagal-induced sinus node dysfunction: Who will be the best candidate for cardioneuroablation? DOI Creative Commons
Simin Cai, Lihui Zheng, Yan Yao

et al.

Frontiers in Physiology, Journal Year: 2023, Volume and Issue: 14

Published: Feb. 7, 2023

Sinus node dysfunction is a multifaceted disorder with variable manifestations, the prevalence of which increases age. In specific group patients, excessive vagal activity may be sole cause for this condition. These patients are characterized as having recurrent daytime symptoms attributed to bradyarrhythmia, no evidence organic sinus lesions, cardiac overactivation, and non-elderly. For permanent pacemaker implantation appears ultimate solution, although it not an etiological treatment. Cardioneuroablation promising emerging therapy that can fundamentally eliminate in highly selective sub-set by nerve denervation. Denervation ablation vagal-induced effectively improve bradycardia reduce syncope. To date, guidelines selection suitable candidates cardioneuroablation remain lacking. The primary objective study was distinguish nature abnormal function find methods quantifying tone. Clear criteria could help physicians identification autonomic imbalance, thereby maximizing patient benefits success rate cardioneuroablations.

Language: Английский

Citations

5
Cardioneuroablation for the management of neurally mediated syncope, sinus bradycardia, and atrioventricular block DOI
Jamario Skeete, J. Gordon,

Lincoln Kavinksy

et al.

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

Published: Sept. 27, 2024

Language: Английский

Citations

1
Cardioneuroablation for successful treatment of symptomatic bradycardia in a 12-year-old child after a 6-month follow-up DOI Creative Commons

Xin Xu,

Shuang He,

Qian Liu

et al.

Frontiers in Cardiovascular Medicine, Journal Year: 2023, Volume and Issue: 10

Published: Nov. 29, 2023

Cardioneuroablation (CNA) is recognized as a promising therapeutic option for adults with severe symptomatic bradycardia caused by excessive vagal tone. However, no pediatric cases have been reported to date. Therefore, the aim of this study evaluate feasibility and efficacy CNA in children.A 12-year-old male patient was hospitalized symptoms fatigue, palpitations, syncope more than 2 months, definitively diagnosed functional sinoatrial node dysfunction using 12-lead electrocardiogram, 24-h Holter monitoring, loading dose atropine test (0.04 mg/kg), treadmill exercise test. Simultaneously, whole-exome sequencing performed on child his core family members. After completing preoperative examination signing informed consent form, underwent therapy.First, electroanatomic structures both atria were mapped out Carto 3 system, according protocol purely anatomy-guided local fractionated intracardiac electrogram-guided methods. Then, electrograms each cardiac ganglionated plexus (GP), including GP between aortic root medial wall superior vena cava, posterior coronary sinus ostium left atrium, anterior antrum right pulmonary vein superolateral area around vein, inferior used targets ablation at power 30 W an index 350-400. At 6-month follow-up, child's heart rhythm saw complete restoration clinical disappeared.The first application achieved better outcomes. can be carried cautiously children under suitable indications.

Language: Английский

Citations

2
The future of cardioneuroablation in cardiovascular medicine DOI

Tolga Aksu,

Asad Khan,

Henry D. Huang

et al.

Expert Review of Cardiovascular Therapy, Journal Year: 2022, Volume and Issue: 20(11), P. 861 - 870

Published: Nov. 2, 2022

Cardioneuroablation is increasingly being utilized to improve outcomes in patients with vagally mediated bradyarrhythmias. However, there are still controversial issues the field including patient selection, safety and efficacy, procedural end-points.In this review, current role of cardioneuroablation summarized, related modality discussed.According small open-label cohort studies, overall freedom from syncope recurrence was higher than 90% after vasovagal (VVS). Use electrogram-based strategy or high-frequency stimulation demonstrate similar success rate except procedures limited right atrium. Based on a recently published randomized controlled trial metanalysis, it may be possible now make strong recommendation for <40 years age, those cardioinhibitory mixed type VVS who continue experience frequent and/or burdensome recurrences. Considering prone significant placebo/expectation effect, sham-controlled trials help quantify placebo effect. In well-selected functional atrioventricular block sinus bradycardia, result encouraging medium-term outcomes. bradycardia identified minority presenting high-grade node dysfunction.

Language: Английский

Citations

3
Short-term deceleration capacity: a novel non-invasive indicator of parasympathetic activity in patients undergoing pulmonary vein isolation DOI Creative Commons
Łukasz Zarębski, Piotr Futyma

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

Published: Aug. 20, 2024

Subtypes of atrial fibrillation (AF) can differ, and exact mechanisms in which patients benefit from the pulmonary vein isolation (PVI) remain not fully understood. During PVI, vagal innervation heart may also be affected. Thus, non-invasive methods intraprocedural assessment such PVI impact are sought.

Language: Английский

Citations

0
Extracardiac vagal stimulation using a widely available neuromuscular monitor DOI Creative Commons
Maxime Beneyto,

Anne Rollin,

Jean Timnou Bekouti

et al.

Heart Rhythm, Journal Year: 2024, Volume and Issue: unknown

Published: July 1, 2024

In the rapidly developing field of cardioneuroablation (CNA),1Pachon M.J.C. Pachon M.E.I. et al."Cardioneuroablation" – new treatment for neurocardiogenic syncope, functional AV block and sinus dysfunction using catheter RF-ablation.EP Europace. 2005; 7: 1-13Crossref PubMed Scopus (223) Google Scholar extracardiac vagal stimulation (ECVS) is a robust procedural endpoint to demonstrate effective cardiac denervation. The only available device ECVS one presented by Pachón, which currently has limited availability, not commercialized, does have CE mark nor FDA approval.2Pachon Santillana P.T.G. al.Simplified Method Vagal Effect Evaluation in Cardiac Ablation Electrophysiological Procedures.JACC Clin Electrophysiol. 2015; 1: 451-460Crossref (85) Technical characteristics needed perform include high rate (20 50 Hz) output pacing.3Chen W. Liu Z. Xiao P. al.Extracardiac Stimulation-Assisted Cardioneuroablation: Dynamically Evaluating Impact Sequential Ganglionated Plexus on Control SAN AVN Patients with Sinoatrial Node Dysfunction.J Cardiovasc Dev Dis. 2022; 9Google search an alternative Pachón's NeuroStimulator, we noted strikingly similar pacing "tetanus mode" commercially Dräger ToFscan neuromuscular monitor (Figure 1A). We report use latter ECVS. A 50-year-old male recurrent vasovagal syncope without avoidable triggers was investigated. Head-up tilt testing implantable loop recordings showed cardio-inhibition mechanism <15-second arrests during syncope. Given patient's young age, discussed benefits drawbacks pacemaker implantation CNA. He expressed his preference therapeutic approach agreed confirm procedure performed under general anesthesia propofol, sufentanil, atracurium. Target ganglionated plexus (GPs) were selected based localization fat pads preprocedural computed tomography. focused radiofrequency applications septal GPs through bi-atrial after transseptal puncture. With deflectable quadripolar placed right internal jugular vein oriented toward superior wisdom tooth fluoroscopy, close vagus nerve, delivered burst "tetanus" mode NeuroMuscular Transmission Monitor 1B). demonstrated: 1) prolonged pause at baseline, 2)a complete atrio-ventricular (AVB) slightly decelerated rhythm ablation inferior GP, then 3) minimal deceleration AVB posteromedial left GP 1C). These results are those previously reported Extra-Cardiac NeuroStimulator Pachón.4Pachon-M E.I. Pachon-Mateos J.C. Higuti C. al.Relation Fractionated Atrial Potentials Innervation Evaluated Extracardiac Stimulation During Cardioneuroablation.Circ: Arrhythmia Electrophysiology. 2020; 13e007900Google At end procedure, near-absence response confirmed from facing teeth. considered this result satisfactory therefore did non-septal GPs. One week later, patient developed mild chest pain pericardial effusion treated colchicine. also pre-syncope episodes but bradycardia ILR. provided lifestyle modification counseling mitigate these residual vasodepressor-related symptoms. obtained consent four other patients 1D). Burst nerve deep sedation beginning atrial fibrillation procedures. three patients, it triggered overt pauses (+179% +374% increase P-P interval). fourth one, generated discrete progressive transient (+38% PP interval) sternocleidomastoid muscle contraction. absence or expected as had received atropine mechanically-induced atrioventricular block. intervals reproducible that observed aortocaval our case (+32%). This first endovascular different than Pachón. demonstrated could yield NeuroStimulator. Tragus recently published performing noninvasive stimulation.5Hanumanthu B.K. Callans D. Marchlinski F.E. Nazarian S. Markman T.M. Feasibility Noninvasive Tragal Assess Tone Cardioneuroablation.JACC: Clinical 2024; S2405500X24001580Crossref (0) It yielded responses, making less clear-cut most salient advantage its allowing assessment effects tone various conditions. From regulatory point view, approved human cutaneous application only. For ECVS, no approval mark, just like Pachóns's device. presents limitations: First, cannot be directly connected multi-electrode catheter, requiring adapters connections usually used external 1E). Second, built-in "cool down" impedes second burst" within 3 minutes. little impact if obtain landmark endpoints may cumbersome detailed analysis desired. Third, maximum deliver much energy 1A); even though apparent cases, might efficacious inducing response. nevertheless interesting option until dedicated devices approval.

Language: Английский

Citations

0
Cardioneuroablation eliminating cardiac asystole associated with area postrema syndrome: a case report and literature review DOI Creative Commons

EnRun Wang,

Yuanjing Li,

Gang Yu

et al.

Frontiers in Cardiovascular Medicine, Journal Year: 2024, Volume and Issue: 11

Published: Oct. 31, 2024

There have been few instances of symptomatic bradycardia-arrhythmia in the context area postrema syndrome (APS), and some them implanted permanent pacemakers. Cardioneuroablation (CNA) has emerged as a viable therapy for treatment syncope induced by neutrally mediated bradycardia or atrioventricular block.

Language: Английский

Citations

0
Cardioneuroablation in the treatment of neurocardiogenic syncope and functional bradyarrhythmias. A literature review DOI Creative Commons
M. V. Gorev, Ф. Г. Рзаев, А.В. Вахрушев

et al.

Russian Journal of Cardiology, Journal Year: 2024, Volume and Issue: 29(4S), P. 6206 - 6206

Published: Dec. 27, 2024

Interest in the autonomic regulation of cardiovascular system does not wane. Changes nervous activity are involved pathogenesis acute and chronic conditions, such as sinus bradycardia, arrest atrioventricular block, vasovagal syncope other types syncopal conditions. Traditional methods prevention treatment conditions include lifestyle changes, pharmacotherapy and, some cases, pacemaker implantation, but many cases they unable to eliminate symptoms or cure disease. We conducted a descriptive review most significant publications on effectiveness development cardiac neuroablation technique patients with neurogenic functional bradyarrhythmias — node dysfunction conduction disorders. This allows effectively prevent neurocardiogenic relapses, reduce tendency by eliminating pathological parasympathetic tone. Cardioneuroablation indications for implantation delay its implementation.

Language: Английский

Citations

0