Initial experience with ablation of the innervation surrounding sinus and atrioventricular nodes to treat paroxysmal bradyarrhythmia  

作　　者：Chun-Shan Lu Cheng-Jun Guo Dong-Ping Fang Peng Hao Dong-Fang He Ai-Guo Xu 

机构地区：[1]Division of Cardiology,Department of Medicine,Beijing Anzhen Hospital,Capital Medical University,Beijing Institute of Heart,Lung and Blood Vessel Diseases,Beijing 100029,China

出　　处：《Chinese Medical Journal》2020年第2期134-140,共7页中华医学杂志（英文版）

摘　　要：Background:The symptomatic bradyarrhythmia is Class I indication for pacing therapy which is not a radical cure.The present study aimed to assess the feasibility and to present the initial results of the restricted ablation of the parasympathetic innervation surrounding sinus and atrioventricular(AV)nodes for treating patients with bradyarrhythmia.Methods:A total of 13 patients with cardiogenic syncope were included from May 2008 to June 2015.Under the guidance of fluoroscopy and/or three-dimensional geometry by 64-slice spiral computed tomography,atrial activation sequence in sinus rhythm was mapped.Chamber geometry was reconstructed manually or automatically using the Niobe II magnetic navigation system integrated with the CARTO-remote magnetic technology(RMT)system.Cardioneuroablation was targeted at the high-amplitude fractionated electrograms surrounding the regions of His bundle and the site with the earliest activation in sinus rhythm.Areas surrounding the sinus node,AV node,and the phrenic nerve were avoided.Results:Thirteen patients completed the studies.Ablation was successfully performed in 12 patients and failed in one.The highfrequency potential was recorded in atrial electrograms surrounding the sinus or AV nodes in all the patients and disappeared in 15 s after radiofrequency applications.The vagal reaction was observed before the improvement of the sinus and AV node function.No complications occurred during the procedures.Patients were followed up for a mean of 13.0±5.9 months.During the follow up ten patients remained free of symptoms,and two patients had a permanent cardiac pacemaker implanted due to spontaneous recurrence of syncope.The heart rate of post-ablation was higher than pre-ablation(69.0±11.0 vs.49.0±10.0 beats/min,t=4.56,P=0.008).The sinus node recovery time,Wenckebach block point,and atrium-His bundle interval were significantly shorter after ablation(1386.0±165.0 vs.921.0±64.0 ms,t=7.45,P=0.002;590.0±96.0 vs.464.0±39.0 ms,t=2.38,P=0.023;106.0±5.0 vs.90.0±12.0 ms,t=9.80,P=0

关 键 词：ELECTROPHYSIOLOGY Radiofrequency ablation SINUS node dysfunction Atrioventricular block SYNCOPE 

分 类 号：R541.7[医药卫生—心血管疾病]