Procedural and short-term results of electroanatomic-mapping-guided ganglionated plexus ablation by first-time operators: A multicenter study.
atrioventricular block
autonomic ganglia
cardioneuroablation
catheter ablation
parasympathetic nervous system
syncope
Journal
Journal of cardiovascular electrophysiology
ISSN: 1540-8167
Titre abrégé: J Cardiovasc Electrophysiol
Pays: United States
ID NLM: 9010756
Informations de publication
Date de publication:
01 2022
01 2022
Historique:
revised:
26
09
2021
received:
28
08
2021
accepted:
18
10
2021
pubmed:
22
10
2021
medline:
22
2
2022
entrez:
21
10
2021
Statut:
ppublish
Résumé
Single-center observational studies have shown promising results with fragmented electrogram (FE)-guided ganglionated plexus (GP) ablation in patients with vagally mediated bradyarrhythmia (VMB). We aimed to compare the acute procedural characteristics during FE-guided GP ablation in patients with VMB performed by first-time operators and those of a single high-volume operator. This international multicenter cohort study included data collected over 2 years from 16 cardiac hospitals. The primary operators were classified according to their prior GP ablation experience: a single high-volume operator who had performed > 50 GP ablation procedures (Group 1), and operators performing their first GP ablation cases (Group 2). Acute procedural characteristics and syncope recurrence were compared between groups. Forty-seven consecutive patients with VMB who underwent FE-guided GP ablation were enrolled, n = 31 in Group 1 and n = 16 in Group 2. The mean number of ablation points in each GP was comparable between groups. The ratio of positive vagal response during ablation on the left superior GP was higher in Group 1 (90.3% vs. 62.5%, p = .022). Ablation of the right superior GP increased heart rate acutely without any vagal response in 45 (95.7%) cases. The procedure time was longer in group 2 (83.4 ± 21 vs. 118.0 ± 21 min, respectively, p < .001). Over a mean follow-up duration of 8.0 ± 3 months (range 2-24 months), none of the patients suffered from syncope. This multi-center pilot study shows for the first time the feasibility of FE-guided GP ablation across a large group of procedure-naïve operators.
Types de publication
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
117-122Informations de copyright
© 2021 Wiley Periodicals LLC.
Références
Aksu T, Guler TE, Bozyel S, et al. Medium-term results of cardioneuroablation for clinical bradyarrhythmias and vasovagal syncope: effects on QT interval and heart rate. J Interv Card Electrophysiol. 2021;60:57-68.
Rivarola EW, Hachul D, Wu T, et al. Targets and end points in cardiac autonomic denervation procedures. Circ Arrhythm Electrophysiol. 2017;10:e004638.
Pachon-M JC, Pachon-M EI, Pachon CTC, et al. Long-term evaluation of the vagal denervation by cardioneuroablation using Holter and heart rate variability. Circ Arrhythm Electrophysiol. 2020;13:e008703.
Hu F, Zheng L, Liang E, et al. Right anterior ganglionated plexus: The primary target of cardioneuroablation? Heart Rhythm. 2019;16:1545-1551.
Aksu T, Guler TE, Mutluer FO, Bozyel S, Golcuk SE, Yalin K. Electroanatomic-mapping-guided cardioneuroablation versus combined approach for vasovagal syncope: a cross-sectional observational study. J Interv Card Electrophysiol. 2019;54:177-188.
Aksu T, Gopinathannair R, Gupta D, Pauza DH. Intrinsic cardiac autonomic nervous system: what do clinical electrophysiologists need to know about the “heart brain”? J Cardiovasc Electrophysiol. 2021;32:1737-1747.
Armour JA, Murphy DA, Yuan BX, Macdonald S, Hopkins DA. Gross and microscopic anatomy of the human intrinsic cardiac nervous system. Anat Rec. 1997;247:289-298.
Nakagawa H, Scherlag BJ, Patterson E, Ikeda A, Lockwood D, Jackman WM. Pathophysiologic basis of autonomic ganglionated plexus ablation in patients with atrial fibrillation. Heart Rhythm. 2009;6(12 Suppl):S26-S34.
Aksu T, Yalin K, Bozyel S, Gopinathannair R, Gupta D. The anatomical basis behind the neuromodulation effects associated with pulmonary vein isolation. J Cardiovasc Electrophysiol. 2021;32:1733-1736.