Long-Term Outcome of Cardiac Denervation Procedures: The Anatomically Guided Septal Approach.
JACC Clin Electrophysiol
; 9(8 Pt 1): 1344-1353, 2023 08.
Article
em En
| MEDLINE
| ID: mdl-37558291
ABSTRACT
BACKGROUND:
Functional bradycardia is a challenging condition that affects a healthy population. Ganglionated plexus ablation has emerged as a therapeutic alternative to avoid a pacemaker.OBJECTIVES:
The purpose of this study is to evaluate long-term effects of anatomically guided cardiac denervation.METHODS:
This is a prospective longitudinal study that included 36 patients with symptomatic functional bradycardia. Electroanatomic reconstruction of both atria was carried out, and the main septal ganglionated plexi were anatomically located and targeted.RESULTS:
Ablation endpoints were 1) heart rate increment; 2) Wenckebach cycle length shortening; and 3) atrio-Hisian (AH) interval shortening. A sinus node denervation was obtained in all patients with an increment of 21.6% in the mean heart rate. All patients presented a negative atropine test after ablation. Twenty-eight (77.7%) patients presented immediate sings of atrioventricular node denervation, with a shortening of 15.6% of mean Wenckebach cycle length and 15.9% of the mean AH interval. All heart rate variability parameters showed a significant reduction after 12 months, enduring after 18 months. Thirty (83.3%) patients remained free of events after a mean follow-up of 52.1 ± 35.2 months. One patient (2.77%) presented acute sinus node artery occlusion during ablation with persistent sinus dysfunction and had a pacemaker implantation; 3 (8.3%) other patients evolved with sinus tachycardia, and 4 (11.1%) patients presented syncope recurrence during follow-up, 3 (8.3%) of them requiring a pacemaker implantation. No other tachyarrhythmia was observed.CONCLUSIONS:
The anatomically guided septal approach is an effective technique for syncope prevention, promoting long-lasting autonomic changes. No significant proarrhythmia effect has been observed during the long-term follow-up.Palavras-chave
Texto completo:
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Base de dados:
MEDLINE
Assunto principal:
Nó Atrioventricular
/
Bradicardia
Idioma:
En
Ano de publicação:
2023
Tipo de documento:
Article