SPC365

Long-term results of cardioneuroablation evaluated by implantable loop recorder

Session: Sessão de Posters 43 - Inovações em Síncope e Pacing Cardíaco
Speaker: Jéni Quintal

Congress: CPC 2024
Topic: C. Arrhythmias and Device Therapy
Theme: 09. Device Therapy
Subtheme: 09.6 Device Therapy - Other
Session Type: Cartazes
FP Number: ---
Authors: Jéni Quintal; Leonor Parreira; Dinis Valbom Mesquita; Rita Marinheiro; Duarte Chambel; Cláudia Encarnação; Cláudia Lopes; Joana Silva Ferreira; Rui Antunes Coelho; Catarina Lagoas Pohle; Patrícia Bernardes; Filipe Seixo
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">Background:&nbsp;</span></span></span></strong><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">Cardioneuroablation (CNA) is a catheter ablation (abl) technique based on radiofrequency application in the atrial endocardium to decrease vagal response. Since the first series publication, its use has greatly increased, with CNA being now used in vasovagal syncope (VVS), functional atrioventricular block (AVB), symptomatic sinus bradycardia (SB) and Atrial Fibrillation (AFib). There is still limited data regarding long-term follow-up (FUP) of patients (pts) who have undergone this procedure.</span></span></span></span></span></p>

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<span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">Purpose</span></span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">: </span></span><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">The</span></span></span> <span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">aim of this study was to evaluate long-term results of CNA in a single center with the use of an implantable loop recorder (ILR).</span></span></span></span></span></p>

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<span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">Methods</span></span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">: </span></span><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">We performed a prospective single-center cohort study. Patients with significant documented functional bradyarrhythmias between September 2019 and October 2023 were enrolled. All pts underwent ILR implantation before abl. CNA was performed using catheter abl aiming at right epicardial GPs with 3-dimensional electroanatomical mapping support. A 2 mg atropine test (bolus) was carried out before and after CNA and the subsequent heart rate (HR) increase registered. Successful CNA was defined as absence of HR increase with atropine after the abl.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">HR pre and post abl was compared. Immediate and late procedure complications were assessed. Recurrence of symptoms, the presence significant vagal-induced bradyarrhythmias on ILR and the need for pacemaker (PM) implantation were also assed.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">Results</span></span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">: </span></span><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">Fifteen pts were included, with a mean age of 64 (</span></span></span><span style="font-size:9.0pt"><span style="font-family:Symbol"><span style="color:#1d1d1d">&plusmn;</span></span></span><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d"> 12) years&nbsp;and a 53.3% male prevalence. None of the pts had structural heart disease. The main indication for CNA was AFib with brady-tachy syndrome (8 pts, 53.3%), followed by VVS (4 pts, 26.7%), SB (2 pts, 13.3%) and AVB (2:1 AVB; 1 pt). The most common symptom was syncope (46.7%), followed by pre-syncope (40%) and fatigue (20%).</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">There was a</span></span></span><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:black"> significant improvement in HR after CNA (55 </span></span></span><span style="font-size:9.0pt"><span style="font-family:Symbol"><span style="color:black">&plusmn;</span></span></span><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:black"> 13 vs. 67 </span></span></span><span style="font-size:9.0pt"><span style="font-family:Symbol"><span style="color:black">&plusmn;</span></span></span><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:black"> 14 bpm pos-CNA, p=0.002). The achievement of success was verified in all pts (mean HR variation with atropine before CNA </span></span></span><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">35 </span></span></span><span style="font-size:9.0pt"><span style="font-family:Symbol"><span style="color:#1d1d1d">&plusmn;</span></span></span><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d"> 10% </span></span></span><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:black">vs. </span></span></span><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">2 </span></span></span><span style="font-size:9.0pt"><span style="font-family:Symbol"><span style="color:#1d1d1d">&plusmn;</span></span></span><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d"> 2% </span></span></span><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:black">after CNA; p=0.001). Procedure mean time was 28 </span></span></span><span style="font-size:9.0pt"><span style="font-family:Symbol"><span style="color:black">&plusmn;</span></span></span><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:black"> 12 min.</span></span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:black">During a maximum FUP of 48 months (minimum 1, median 5 months), 1 patient had recurrence of VVS with a 10s pause documentation on ILR requiring PM implantation and 1 patient had a 4s pause without translation into symptoms and a duration decreasing tendency during FUP. Freedom from recurrence of symptoms was 93.3%, freedom from pacemaker implantation was 93.3% and freedom from significant bradyarrhythmias was 86.7% &ndash; </span></span></span><em><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">Figure</span></span></span></em> <em><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">1.</span></span></span></em> <span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:black">No </span></span></span><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">immediate or </span></span></span><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:black">long-term complications were seen.</span></span></span></span></span></p>

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<span style="font-size:12pt"><span style="font-family:&quot;Times New Roman&quot;,serif"><strong><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">Conclusions</span></span></span></strong><span style="font-size:10.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">: </span></span><span style="font-size:9.0pt"><span style="font-family:&quot;Avenir Book&quot;"><span style="color:#1d1d1d">CNA aiming at the right GPs is a safe and quick procedure for pts with functional bradyarrhythmias. This abl technique in most pts not only reduces symptoms, but also avoids early PM implantation, therefore improving quality of life. Further randomized clinical trials are needed to support these data and refine patient selection criteria.</span></span></span></span></span></p>