Journal of Interventional Cardiac Electrophysiology最新文献

{"title":"Permanent pacing versus cardioneuroablation for cardioinhibitory vasovagal syncope.","authors":"Rakesh Gopinathannair, Brian Olshansky, Mohit K Turagam, Sandeep Gautam, Piotr Futyma, Krishna Akella, Halil Ibrahim Tanboga, Serdar Bozyel, Kivanc Yalin, Deepak Padmanabhan, Jayaprakash Shenthar, Dhanunjaya Lakkireddy, Tolga Aksu","doi":"10.1007/s10840-022-01456-x","DOIUrl":"10.1007/s10840-022-01456-x","url":null,"abstract":"<p><strong>Background: </strong>We compared the efficacy and safety of cardioneuroablation (CNA) vs. permanent pacing (PM) for recurrent cardioinhibitory vasovagal syncope (CI-VVS).</p><p><strong>Methods: </strong>One hundred sixty-two patients (CNA = 61, PM = 101), age 36 + 11 years) with syncope frequency of 6.7 ± 3.9/year were included in this multicenter study. All patients with CNA were provided by a single center, while patients with PM were provided by 4 other centers. In the CNA arm, an electroanatomic mapping guided approach was used to detect and ablate ganglionated plexus sites. Dual chamber rate drop response (RDR) or close loop stimulation (CLS) transvenous and leadless pacemakers were implanted using standard technique. The primary endpoint was freedom from syncope.</p><p><strong>Results: </strong>Of 101 patients in the PM group, 39 received dual-chamber pacemaker implants with the CLS algorithm, 38 received dual-chamber pacemakers with the RDR algorithm, and 24 received a leadless pacemaker. At 1-year follow-up, 97% and 89% in the CNA and PM group met the primary endpoint (adjusted HR = 0.27, 95% CI 0.06-1.24, p = 0.09). No significant differences in adverse events were noted between groups. There was no significant association between age (HR:1.01, 95% CI 0.96-1.06, p = 0.655), sex (HR:1.15, 95% CI 0.38-3.51, p = 0.809), and syncope frequency in the past year (HR:1.10, 95% CI 0.97-1.25, p = 0.122) and the primary outcome in univariable analyses.</p><p><strong>Conclusions: </strong>After adjustment for patient characteristics, the medium-term syncope recurrence risk of CI-VVS patients who underwent CNA was similar to that of a population of patients undergoing pacemaker implantation with a similar safety profile.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"203-210"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10425610","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neuromodulation for ventricular arrhythmias: progress-but are we there yet?","authors":"Henry D Huang, Tolga Aksu, Jeffrey Winterfield","doi":"10.1007/s10840-024-01910-y","DOIUrl":"10.1007/s10840-024-01910-y","url":null,"abstract":"","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"379-380"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142108200","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Quality of life improvement following cardioneuroablation for vasovagal syncope: expected or too early to say?","authors":"Bosky Soni, Dhiraj Gupta, Rakesh Gopinathannair","doi":"10.1007/s10840-023-01489-w","DOIUrl":"10.1007/s10840-023-01489-w","url":null,"abstract":"","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"253-255"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10623710","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardioneural ablation-the first case series without the use of fluoroscopy.","authors":"Daniel Alyesh, Nicholas Palmeri, Benjamin Jones, Samantha Hanslip, William Choe, Sri Sundaram","doi":"10.1007/s10840-024-01881-0","DOIUrl":"10.1007/s10840-024-01881-0","url":null,"abstract":"<p><strong>Introduction: </strong>Cardioneural ablation (CNA) and fluoroless ablation (FA) are emerging procedures and movements in contemporary in electrophysiology. Ablation of ganglionated plexus (GP) inputs in the atrium has been successfully targeted as a treatment for symptomatic bradyarrhythmias due to increased parasympathetic tone. As most of these patients are young, avoidance of ionizing radiation is of critical importance to limit potential long term deleterious effects. With widespread use of 3D electroanatomic mapping systems and advanced intracardiac echo (ICE) imaging, fluoroless ablation has become more widely adopted. However, fluoroless CNA has not been widely performed. The objective of this study is to demonstrate that CNA can be done safely and effectively without fluoroscopy.</p><p><strong>Methods: </strong>At a single-center, consecutive patients undergoing CNA with a fluoroless approach are described. GP mapping and ablation were performed in both atria. From the right atrium (RA), the right atrium-superior vena cava (RA-SVC GP), the posteromedial ganglionated plexus (PMLGP), which can be accessed from the right atrium-coronary sinus ostium, and the Vein of Marshall GP (VOM-GP) were evaluated. From the left atrium (LA), the superior left atrial ganglionated plexus (LSGP), the left inferior ganglionated plexus (LIGP), the right anterior ganglionated plexus (RAGP), and the right inferior ganglionated plexus (RIGP) were targeted.</p><p><strong>Results: </strong>Over the study period, beginning on January 31, 2021, 30 consecutive subjects (15 females/15 males) aged 42.9 ± 13.6 years underwent GP ablation. The average subject had 9.5 (± 9.2) episodes of syncope prior to ablation. The average CHADS₂-VA₂SC score was zero. The average LVEF was 64.8% (± 4.9). Two of the subjects had concomitant ablations, six failed prior medical therapy, and one had a prior pacemaker placed. All of the procedures were done without fluoroscopy. The average follow-up was 604 (± 366) days. There were 8 patients that did not improve symptomatically postfirst ablation. Four of the eight underwent repeat ablation and have subsequently improved. 26/30 patients symptomatically improved after the 1^st or 2^nd ablation. There were no complications noted.</p><p><strong>Conclusion: </strong>In comparison to the traditional CNA with fluoroscopy, this proof of concept study reveals fluoroless GP ablation can be performed safely. In addition, the durability and success rate are comparable to other studies of CNA. Given the young age of the cohort and the longitudinal risks of ionizing radiation, fluoroless CNA is a feasible procedure for this patient population.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"433-439"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141875083","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Incidental parasympathetic cardiac denervation during atrial fibrillation ablation using high power short duration: a marker of long-term success.","authors":"Fabricio Vassallo, Lucas Corcino, Christiano Cunha, Eduardo Serpa, Carlos Lovatto, Aloyr Simoes, Hermes Carloni, Dalton Hespanhol, Dalbian Gasparini, Luiz Fernando Barbosa, Andre Schmidt","doi":"10.1007/s10840-023-01653-2","DOIUrl":"10.1007/s10840-023-01653-2","url":null,"abstract":"<p><strong>Background: </strong>There are multiple factors in both technique and substrate that lead to recurrence of atrial fibrillation after ablation. We sought to examine whether the degree of heart rate increase (HRI) caused by concurrent high-power-short-duration (HPSD) incidental parasympathetic denervation during AF ablation predicts long term success. Between December 2018 and December 2021, prospectively enrolled 214 patients who presented in sinus rhythm at AF ablation. Used 50 W of power and contact force (CF) of 5-15 g and 10-20 g at a flow rate of 40 mL/min on the anterior and posterior left atrial walls, respectively.</p><p><strong>Results: </strong>Males were 143 (66.8%) and paroxysmal was 124 (57.9%) patients. Mean age 61.1 ± 12.3 years and follow-up time was 32.8 ± 13.2 months. Arrhythmia occurred after 90 days in 39 (18.2%) patients, 19 (48.7%) from the paroxysmal and 20 (51.3%) from the persistent AF patients. Recurrence group showed a lower HRI from a mean of 57 ± 7.7 to 64.4 ± 10.4 bpm (12.3%) while in success group HRI was from 53.8 ± 9.7 to 66.8 ± 11.6 bpm [(24.2%) p = 0.04]. We divided HRI in 3 percentiles of ≤ 8%, > 8 ≤ 37% and > 37%. A predictor of recurrence was identified in those in the first (< 8%, p = 0.006) and a predictor of success in the later (> 37%, p = 0.01) HRI percentile.</p><p><strong>Conclusion: </strong>Atrial fibrillation ablation with HPSD incidental cardiac parasympathetic denervation identified that patients with lower heart rate increase are prone to recurrence while those with higher heart rate increase had higher maintenance of sinus rhythm at a long-term follow-up.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"371-377"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41139088","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardioneuroablation for the management of neurally mediated syncope, sinus bradycardia, and atrioventricular block.","authors":"Jamario Skeete, Jonathan S Gordon, Lincoln Kavinksy, Henry D Huang, Tolga Aksu","doi":"10.1007/s10840-024-01923-7","DOIUrl":"10.1007/s10840-024-01923-7","url":null,"abstract":"<p><p>Through several decades of medical advances, we have improved our understanding of the role of the autonomic nervous system in the production of a myriad of clinical cardiac conditions such as vasovagal syncope, situational syncope, carotid sinus hypersensitivity, vagally mediated sinus bradycardia, and atrioventricular block. While typically not associated with mortality, these common clinical entities may result in significant patient symptoms and morbidity and are often characterized by a frustrating treatment course with a paucity of effective strategies. In recent years, there has been increased interest in the management of these conditions via direct modulation of the parasympathetic component of the autonomic nervous system. This is achieved by targeting the ganglionated plexus central to the pathogenesis of these conditions via cardioneuroablation. The primary role of this strategy is evolving and serves to augment traditional treatment strategies such as lifestyle modification and pharmacotherapy. In this review, we examine the principles governing the role of cardioneuroablation in select populations with vasovagal syncope, sinus dysfunction, and atrioventricular block including the evolving evidence in this exciting field while keeping in mind the need for robust clinical studies examining the long-term effectiveness and safety.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"281-292"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142348326","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fluoroscopy-free cardioneuroablation for functional bradycardia: a single-center experience.","authors":"Parnia Abolhassan Choubdar, Megan Gruber, Jose Carlos Pachon-M, Stephen Manu, Mansour Razminia, John Clark","doi":"10.1007/s10840-024-01926-4","DOIUrl":"10.1007/s10840-024-01926-4","url":null,"abstract":"<p><strong>Background: </strong>Cardioneuroablation (CNA) is an emerging treatment for cardioinhibitory syncope and functional AV block. This study aimed to evaluate the safety and efficacy of a fluoroless CNA approach using three-dimensional mapping and extracardiac vagal stimulation (ECVS).</p><p><strong>Methods: </strong>This prospective observational study included 22 patients (mean age 21 years) with clinically significant functional bradycardia who underwent fluoroless CNA. Procedural success was defined as elimination or significant attenuation of the vagal response to ECVS.</p><p><strong>Results: </strong>CNA was successfully performed in all patients with a mean procedure time of 251 min. Fluoroscopy was avoided in 91% of cases. At a mean follow-up of 11.4 months, 77% of patients remained symptom-free. Among pacemaker patients, 90% did not require further pacing, and 6/10 (60%) have had their pacemakers turned off. No complications were seen during the procedure.</p><p><strong>Conclusions: </strong>Fluoroscopy-free CNA is a safe and effective treatment for functional bradycardia, offering high procedural success rates and favorable symptom-free outcomes while minimizing radiation exposure.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"443-453"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142391105","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Unicentric Brazilian registry of cardiac sympathetic denervation for control of ventricular arrhythmias.","authors":"Rodrigo M Kulchetscki, Paulo Henrique Peitl Gregório, Gabrielle D 'Arezzo Pessente, Cristiano F Pisani, Muhieddine O Chokr, Carina A Hardy, Luciana Sacilotto, Francisco Carlos da Costa Darrieux, Denise Hachul, Mauricio I Scanavacca, Paulo M Pêgo-Fernandes","doi":"10.1007/s10840-024-01975-9","DOIUrl":"10.1007/s10840-024-01975-9","url":null,"abstract":"","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"405-409"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142978946","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Safety and outcomes of surgical cardiac sympathetic denervation when used as salvage therapy among high-risk patients with refractory ventricular arrhythmias.","authors":"Brett Curtis, Gabriella VanAken, Mohammed Al-Sadawi, Hamid Emami, William R Lynch, Amrish Deshmukh, Michael Ghannam, Rakesh Latchamsetty, Frank Bogun, Jackson J Liang","doi":"10.1007/s10840-024-01874-z","DOIUrl":"10.1007/s10840-024-01874-z","url":null,"abstract":"","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"411-413"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141616669","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Short-term deceleration capacity: a novel non-invasive indicator of parasympathetic activity in patients undergoing pulmonary vein isolation.","authors":"Łukasz Zarębski, Piotr Futyma","doi":"10.1007/s10840-024-01899-4","DOIUrl":"10.1007/s10840-024-01899-4","url":null,"abstract":"<p><strong>Background: </strong>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 of the heart may also be affected. Thus, non-invasive methods of intraprocedural assessment of such PVI impact are sought.</p><p><strong>Methods: </strong>From 1-minute ECG recordings performed before and after PVI, we investigated short-term deceleration capacity (ST-DC) and short-term heart rate variability (ST-HRV) to determine their potential as indicators of parasympathetic activity before and after ablation.</p><p><strong>Results: </strong>In 24 consecutive patients with paroxysmal AF included in the study, there were a significant differences in ST-DC and ST-HRV parameters measured before and after PVI. After 3 months, patients with baseline ST-DC ≥ 7.5 ms were less likely to experience AF recurrence when compared to patients with baseline ST-DC < 7.5 ms (0% vs 31%, p = 0.0496). There were no differences in AF recurrence after 12 months of follow-up (36% vs 38%, p = 0.52).</p><p><strong>Conclusion: </strong>PVI leads to significant changes in ST-DC and ST-HRV, and these parameters can serve as indicators of vagal denervation after AF ablation. Patients with more prominent baseline ST-DC are less likely to experience AF recurrence during the post-PVI 3-month blanking period.</p>","PeriodicalId":16202,"journal":{"name":"Journal of Interventional Cardiac Electrophysiology","volume":" ","pages":"455-464"},"PeriodicalIF":2.1,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12043757/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142004421","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}