ABSTRACT
Resumo 57028: trabalho apresentado no 37º Congresso de Cardiologia da SOCERJ
Subject(s)
Vena Cava, Superior , Chagas Cardiomyopathy , Pacemaker, ArtificialABSTRACT
A 23-year-old-female patient had undergone a very successful gastric banding surgery to treat obesity. Sixmonths later she began to present recurrent syncope due to very frequent, intermittent high-degree AV block referred to as pacemaker implantation. The electrophysiological study showed impaired AV nodalconduction but the His-Purkinje conduction was preserved. Partial catheter radiofrequency ablation of thecardiac autonomic nervous system guided by spectral endocardial mapping (cardioneuroablation) was performed. The electrophysiological parameters were normalized. Holter recordings were normal and the patient was asymptomatic with normal life without pacemaker implantation in a follow-up 21 months later.
Subject(s)
Female , Adult , Humans , Electrophysiology , Gastrectomy/methods , Obesity/surgery , Weight Loss , Syncope/diagnosisABSTRACT
Cardiac neuroablation is a new technique for management of patients with dominantly adverse parasympathetic autonomic influence. The technique is based on radiofrequency (RF) ablation of autonomic connections in the three main ganglia around the heart. Their connections are identified by Fast-Fourier Transforms (FFTs) of endocardial signals: sites of autonomic nervous connections show fractionated signals with FFTs shifted to the right. In contrast, normal myocardium without these connections does not show these features. RF-ablation is thought to inflict permanent damage on the parasympathetic autonomic influence because its cells are adjacent to the heart whereas sympathetic cells are remote. Twenty-one patients with a mean age of 48 years, neurally mediated reflex syncope in six, functional high grade atrioventricular block in seven and sinus node dysfunction in 13 (there is overlap between the second and third groups) were treated. Follow-up for a mean of 9.2 months demonstrated success in all cases with relief of symptoms. No complications occurred.
Subject(s)
Catheter Ablation , Arrhythmia, Sinus , Heart Block , Syncope, VasovagalABSTRACT
By studying the spectrum of atrial potentials by fast Fourier transform (FFT) we have found two types of atrial muscle: the compact (CM) and the fibrillar (FM) myocardium. The former presents normal in-phase conduction inferring a great number of cellular connections, long-lasting refractoriness and left ward FFT-shift. The latter shows anisotropic out-of-phase conduction, fewer cellular connections, short refractoriness and a segmented right-FFT-shift. The compact is the normal predominant muscle and the fibrillar is different and may be neural input, vein insertion, interatrial (IA) septum, left atrial (LA) roof, etc. or pathological tissue, being so by loss of cellular connections this is a possible mechanism for conversion of compact into fibrillar-like myocardium. During atrial fibrillation (AF), clusters of FM (AF nests) present higher frequencies than any surrounding tissue. Purpose The purpose was to describe a new method for paroxysmal AF RFablation targeting AF nests. Method Forty patients, six control and 34 having idiopathic drug-refractory paroxysmal or persistent AF were studied and treated. Two catheters were placed in the LA by transseptal approach. RF (30e40 J/60e70 (C) was applied to all sites outside the pulmonary veins (PV) presenting right-FFT-shift (AF nests). Results Numerous AF nests were found in 34/34 AF patients and only in 1/6 controls (only in this case was it possible to induce AF despite an absence of AF history). The main FM sites were: LA roof, LA septum, close to the insertion of the superior PV, near the insertion of the inferior PV, LA posterior wall, RA near the superior vena cava insertion, RA lateral and anterior wall and the right IA septum. Ablation of all AF nests near PV insertions resulted in 35 PV isolations.
