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The role of cardioneuroablation for the treatment of heart rhythm disorders
Session:
Comunicações Orais - Sessão 05 - Arritmologia: da cardioneuroablação até à inteligência artificial
Speaker:
Sofia B. Paula
Congress:
CPC 2024
Topic:
C. Arrhythmias and Device Therapy
Theme:
04. Arrhythmias, General
Subtheme:
04.4 Arrhythmias, General – Treatment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Sofia B. Paula; Margarida Figueiredo; Helena Fonseca; Sara Laginha; Sofia Jacinto; Ana Raquel Santos; Hélder Santos; Bruno Valente; Ana Lousinha; Guilherme Portugal; Pedro Silva Cunha; Mário Oliveira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="color:black">Introduction:</span></strong><span style="color:black"> The impact of autonomic modulation of the heart in different pathophysiologic conditions has been the subject of various studies. Cardioneuroablation (CNA) is a novel method of bradyarrhythmia management targeting neuromodulation of the cardiac autonomic nervous system, enabling a sudden postprocedural increase in sinus rhythm, thereby providing an attractive treatment option without the necessity for PM implantation in sinus node dysfunction (SND), atrioventricular blocks (AVB) and vasovagal syncope (VVS). </span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods:</strong> Single-center retrospective study evaluating patients who had SDN, AVB and VVS and underwent CNA during a 54-month period. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results: </strong>We screened 9 patients who underwent CNA in a 54-month period. The mean age of patients was 33.9 (±5.5) years and 55.6% were males. Regarding CV risk factors only one patient had active smoking habits, no other CV risk factors were found. The majority of patients (77.8%) practiced sports; some patients did high-intensity training in various modalities. Symptomatology varied between syncope (55.6%), dizziness (44.4%) and palpitations. </span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">We evaluate the mean HR prior and after CNA, the mean HR before CNA was 76.9 (±7.7) bpm and after was 84.7 (±8.0) bpm, the difference was statistically significant P<0.001. We also evaluated the occurrence of 1<sup>st</sup>, 2<sup>nd</sup> (Mobitz I and II) and high degree AVB, 55.6% vs 44.4%; 66.7% vs 11.1% and 44.4% vs 11.1%; and 22.2% vs 11.1%, respectively. No 3<sup>rd</sup> degree AVB was detected and 33.3% of patients had significant sinus pauses (≥3s) before CNA that subsided after the CNA. Tilt tests was performed before and after CNA in 66.7% of patients. Before de CNA 2 patients had a negative tilt test, 2 with a response 2B with 19 and 90s of asystole, one with 2A response and one patient with POTS. After CNA all patients except one had negative tilt tests, the patient with previous 2A response after CNA had a type 1 response. The improvement of results in tilt test after CNA was statistically significant p=0.005. Symptoms also improved after CNA, except in 2 patients, one female patient who had high degree AB block before and after CNA and a male patient with POTS who had recurrent previously and after CNA syncope episodes and a dual-chamber pacemaker was implanted afterwards. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion: </strong>CNA<span style="color:black"> is a safe and efficient procedure, allowing a significant increase in heart rate, suppressing AVB and VVS and decreasing the necessity for PM implantation in younger patients. </span></span></span></p>
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