John Leah A, Mullis Andin, Payne Joshua, Tung Roderick, Aksu Tolga, Winterfield Jeffrey R
Division of Cardiology, Medical University of South Carolina, Charleston, SC, USA.
The University of Chicago Medicine Center for Arrhythmia Care, Pritzker School of Medicine, Chicago, IL, USA.
J Innov Card Rhythm Manag. 2021 Apr 15;12(4):4473-4476. doi: 10.19102/icrm.2021.120405. eCollection 2021 Apr.
Cardioneuroablation (CNA) is an emerging technique used to treat patients with vasovagal syncope (VVS). We herein describe a case of CNA targeting the atrial ganglionated plexi (GPs) based upon anatomical landmarks and fractionated electrogram (EGM) localization in a 20-year-old healthy female who presented to our center with malignant VVS and symptomatic sinus pauses, the longest of which measured 10 seconds. She underwent acutely successful CNA with a demonstration of vagal response noted following ablation of the left-sided GPs, and tachycardia was noted with right-sided GP ablation. All GP sites were defined by anatomical landmarks and EGM analysis. By using the fractionation mapping software of the EnSite Precision™ cardiac mapping system (Abbott, Chicago, IL, USA) with high-density mapping, fragmented EGMs were successfully detected in each GP site. One month after vagal denervation, no recurrent syncopal episodes or sinus pauses had been recorded. Longer-term follow-up with an implantable loop recorder is planned. Broadly, we performed CNA in a patient with VVS by combining high-density mapping and fractionation mapping software in a novel approach, which allowed us to detect fractionation in all GP sites and demonstrate an acute vagal response. This workflow may facilitate the introduction of a standardized technique suitable for widespread use.
心脏神经消融术（CNA）是一种用于治疗血管迷走性晕厥（VVS）患者的新兴技术。在此，我们描述了一例针对心房神经节丛（GPs）进行CNA的病例，该病例基于解剖标志和碎裂电图（EGM）定位，患者为一名20岁健康女性，因恶性VVS和症状性窦性停搏前来我院就诊，最长窦性停搏时间达10秒。她接受了CNA，手术即刻成功，在消融左侧GPs后出现迷走反应，消融右侧GPs时出现心动过速。所有GPs部位均通过解剖标志和EGM分析确定。通过使用美国雅培公司位于伊利诺伊州芝加哥的EnSite Precision™心脏标测系统的碎裂标测软件进行高密度标测，在每个GPs部位均成功检测到碎裂EGM。迷走神经去支配术后1个月，未记录到复发性晕厥发作或窦性停搏。计划使用植入式环形记录仪进行长期随访。总体而言，我们采用一种新方法，通过结合高密度标测和碎裂标测软件，对一名VVS患者进行了CNA，这使我们能够在所有GPs部位检测到碎裂情况，并证明了急性迷走反应。这种工作流程可能有助于引入一种适合广泛应用的标准化技术。
