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Case Reports
. 2022 Aug 3;4(15):990-995.
doi: 10.1016/j.jaccas.2022.04.029.

Treatment of Symptomatic Functional Atrioventricular Block by Cardioneuroablation as an Alternative to Pacemaker Implantation

Jose Carlos Pachon-M  1   2   3 , Felipe Augusto Ortencio  1 , Enrique Indalecio Pachon-M  1   2   3 , Tasso Lobo  1 , Tomas Guilhermo Santillana-P  1 , Carlos Thiene Pachon  1 , Maria Zelia Cunha-P  2 , Juan Carlos M Pachon-M  1   2   3 , Juan Carlos Zerpa-A  1 , Ricardo Carneiro Amarante  1   2   3
Affiliations
Case Reports

Treatment of Symptomatic Functional Atrioventricular Block by Cardioneuroablation as an Alternative to Pacemaker Implantation

Jose Carlos Pachon-M et al. JACC Case Rep. .

Abstract

A woman with recurrent presyncope caused by a functional atrioventricular (AV) block after meals, with limiting symptoms, underwent cardioneuroablation and AV node vagal denervation without pacemaker implantation. Normal AV conduction was recovered with complete abolishment of symptoms. (Level of Difficulty: Advanced.).

Keywords: 3D, 3-dimensional; AF, atrial fibrillation; AV, atrioventricular; AVB, atrioventricular block; CNA, cardioneuroablation; ECVS, extracardiac vagus nerve stimulation; EPS, electrophysiological study; ablation; atrial fibrillation; bradycardia; cardiac pacemaker; electrophysiology; palpitations; seizures; supraventricular arrhythmias.

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Conflict of interest statement

The authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
7-Day Loop Recording Showing Symptomatic Paroxysmal High-Degree Atrioventricular Block After Meals There is no PP interval modification.
Figure 2
Figure 2
Extracardiac Vagal Stimulation (A) Neurostimulator. (B) Catheter progression within the internal jugular vein. (C) Close relationship of the vagus with the vein. (D) X-ray with the catheter placed at the left jugular foramen (yellow arrow).
Figure 3
Figure 3
Left Vagus Stimulation Pre- and Post-CNA (A) Left vagus stimulation pre-cardioneuroablation (CNA), showing vagal atrioventricular block (AVB) without sinus node depression. (B) Left vagus stimulation post-CNA, showing no bradycardia and no AVB. (C) Left vagus stimulation post-CNA showing no AVB, even with high-frequency atrial pacing. A Pacing = atrial pacing; AV = atrioventricular; Brady = bradycardia; Stim = stimulation.
Figure 4
Figure 4
Atrial Fibrillation Nest Mapping of Sites of Cardioneuroablation Radiofrequency Application and Presumed Location of Ganglionated Plexuses Red dots indicate sites of cardioneuroablation radiofrequency application and green dots indicate the presumed location of ganglionated plexuses in a 3-dimensional navigation system (Ensite Velocity, Abbott) obtained by atrial fibrillation nest mapping using fractionation software.
Figure 5
Figure 5
Holter Monitoring 24 Months Post-Cardioneuroablation Showing Normal Atrioventricular Conduction AV = atrioventricular; HR = heart rate.
Figure 6
Figure 6
Selective AV Block Induced by Extracardiac Vagus Nerve Stimulation Different responses to the extracardiac vagus nerve stimulation depending on the frequency. Left vagus stimulation at 10 Hz may reproduce the selective atrioventricular (AV) nodal inhibition without sinus depression.
See this image and copyright information in PMC

References

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