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07. Syncope and Bradycardia
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Anatomic guided ablation of the right ganglionated plexus is enough for cardiac autonomic denervation in patients with significant bradyarrhythmias
Session:
Sessão de Comunicações Orais - Arritmias
Speaker:
Dinis Mesquita
Congress:
CPC 2020
Topic:
C. Arrhythmias and Device Therapy
Theme:
07. Syncope and Bradycardia
Subtheme:
07.4 Syncope and Bradycardia - Treatment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Dinis Valbom Mesquita; Leonor Parreira; Pedro Lopes Do Carmo; Diogo Cavaco; Pedro Campos Amador; Rita Marinheiro; Francisco Moscoso Costa; Marta Ferreira Fonseca; José Maria Farinha; Ana Fátima Esteves; Antonio Pinheiro Cumena Candjondjo; Artur Lopes; Mauricio Scanavacca; Pedro Adragão
Abstract
<p><strong>Background</strong>: In patients with significant bradyarrhytmias, cardiac denervation is an alternative therapeutic approach. Previous reports proposed different methods (as high frequency stimulation of ganglionated plexus and voltage mapping) and targets (right and left atrial ganglionated plexus) for adequate denervation. There is no consensus on the best way to perform these procedures, in spite the right atrial ganglia plexus (GP) ablation seeming to be the most contributive to its success.</p> <p><strong>Purpose</strong>: We aim to understand if performing anatomic guided ablation of just the atrial right plexus proves to be a valid and successful strategy to perform cardiac denervation in patients with severe bradyarrhytmias.</p> <p><strong>Methods</strong>: We enrolled patients with severe symptomatic bradyarrhytmias (sinus arrest, transient AV block and cardioinhibitory syncope), after exclusion of reversible causes. We performed eletroanatomic mapping of the right and left atria and used an irrigated tip catheter for ablation, aiming at the anterior right GP at the right pulmonary veins antrum along with ablation at the superior vena cava junction and the inferior right GP at the posterior aspect of the right inferior pulmonary vein along with ablation of the right aspect of the interatrial septum, between the posterior wall and coronary sinus ostium (Figure 1). We assessed the PW and Wenckenback cycle lengths (CL) pre and post procedure in patients with sinus arrest or AV block, respectively, and the patients had new 24h holter readings at least 30 days from the index procedure.</p> <p><strong>Results</strong>: We enrolled 12 patients: 9 males (75%), median age of 49,5 years (IQR 36-61,75). All patients had structurally normal hearts. Overall, 5 patients had simultaneous pulmonary vein isolation for previously documented atrial fibrillation. Among the cohort 2 patients had ILR and 2 were diagnosed upon Tilt testing. There were 7 patients (58,3%) with sinus bradycardia (2 patients had sinus arrest with pauses of 8 and 13 seconds), 2 patients with cardioinhibitory syncope (with pauses of 23 and 28 seconds) and 3 patients were referred for transient high grade AV block. The ablation procedure led to a median sinus rate acceleration of 15 bpm (IQR 3-29), a median decrease of 320 ms in PW (IQR 23,75-609,5) in patients with sinus arrest and a decrease of 80 ms in wenckenback CL (IQR 60-200) in patients with AV block. With a median follow up of 133,50 days (IQR 36-61,75), no patient had recurrence of symptoms and there was no recurrence of pauses or AV block among the cohort.</p> <p><strong>Conclusions</strong>: In selected patients with severe functional paroxysmal bradyarrhytmias, cardiac denervation using an ablation strategy purely based on anatomic aspects and targeting only the right GP, seems to be an effective therapeutic approach.</p>
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