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Review
. 2019 Mar 15:7:2050312119836308.
doi: 10.1177/2050312119836308. eCollection 2019.

Potential usage of cardioneuroablation in vagally mediated functional atrioventricular block

Tolga Aksu  1 , Tumer Erdem Guler  1 , Serdar Bozyel  1 , Kivanc Yalin  2
Affiliations
Review

Potential usage of cardioneuroablation in vagally mediated functional atrioventricular block

Tolga Aksu et al. SAGE Open Med. .

Abstract

An increase in parasympathetic tone may be the main cause of some transient or permanent atrioventricular block cases. Some of these patients, defined as vagally mediated functional atrioventricular block, may be severely symptomatic and refractory to conventional therapies and may necessitate cardiac pacing. Cardioneuroablation is a relatively new strategy for management of patients with excessive vagal activation based on radiofrequency catheter ablation of main ganglionated plexi around the heart. Present review was dedicated to discuss potential usage of cardioneuroablation in patients with vagally mediated functional atrioventricular block.

Keywords: Cardiovascular; ablation; bradycardia; parasympathetic; syncope.

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Conflict of interest statement

Declaration of conflicting interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
A modified schematic view of GPs according to animal and human studies. The figure shows the commonly used location sites for GPs and different electrogram patterns seen in atria. Brown dots demonstrate ablation points. Ablation points were selected in the sites revealing high-amplitude or low-amplitude fractionated electrograms. Yellow dots demonstrate phrenic nerve trace by high-amplitude stimulation. Red ellipse demonstrates superior (anterior) right ganglionated plexus. Blue ellipse shows inferior (posterior) right ganglionated plexus. Brown ellipse reveals posterior right atrial ganglionated plexus. Green circle demonstrates posterolateral left ganglionated plexus. Yellow circle reveals posteromedial left ganglionated plexus. Since the vein of Marshall is also rich in parasympathetic neurons, it is added to the figure. CS, the coronary sinus; HAFE, high-amplitude fractionated electrogram; IVC, the inferior vena cava; LAFE, low-amplitude fractionated electrogram; LIPV, the left inferior pulmonary vein; LL, left lateral view; LSPV, the left superior pulmonary vein; Normal, atrial electrogram demonstarting non-GP sites; PA, postero-anterior view; RIPV, the right inferior pulmonary vein; RSPV, the right superior pulmonary vein; SVC, the superior vena cava; VOM, the vein of Marshall.
See this image and copyright information in PMC

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