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Multicenter Study
. 2024 Jul 2;26(7):euae164.
doi: 10.1093/europace/euae164.

Procedural and Intermediate-term Results of the Electroanatomical-guided Cardioneuroablation for the Treatment of Supra-Hisian Second- or Advanced-degree Atrioventricular Block: the PIRECNA multicentre registry

Tolga Aksu  1 , Roman Piotrowski  2 , Roderick Tung  3 , Tom De Potter  4 , Timothy M Markman  5 , Jeanne du Fay de Lavallaz  6 , Roin Rekvava  7 , Daniel Alyesh  8 , Jacqueline E Joza  9 , Patrick Badertscher  6 , Duc H Do  10 , Jason S Bradfield  10 , Gaurav Upadhyay  11 , Nitesh Sood  12 , Parikshit S Sharma  13 , Tumer Erdem Guler  14 , Enes Elvin Gul  15 , Vineet Kumar  16 , Buelent Koektuerk  17   18 , Alexander Romeno Janner Dal Forno  19 , Christopher E Woods  20 , Moshe Rav-Acha  21 , Chiara Valeriano  4 , Andres Enriquez  5   22 , Sri Sundaram  8 , Michael Glikson  21 , Andre d'Avila  23 , Kalyanam Shivkumar  10 , Piotr Kulakowski  2 , Henry D Huang  13
Affiliations
Multicenter Study

Procedural and Intermediate-term Results of the Electroanatomical-guided Cardioneuroablation for the Treatment of Supra-Hisian Second- or Advanced-degree Atrioventricular Block: the PIRECNA multicentre registry

Tolga Aksu et al. Europace. .

Abstract

Aims: Prior case series showed promising results for cardioneuroablation in patients with vagally induced atrioventricular blocks (VAVBs). We aimed to examine the acute procedural characteristics and intermediate-term outcomes of electroanatomical-guided cardioneuroablation (EACNA) in patients with VAVB.

Methods and results: This international multicentre retrospective registry included data collected from 20 centres. Patients presenting with symptomatic paroxysmal or persistent VAVB were included in the study. All patients underwent EACNA. Procedural success was defined by the acute reversal of atrioventricular blocks (AVBs) and complete abolition of atropine response. The primary outcome was occurrence of syncope and daytime second- or advanced-degree AVB on serial prolonged electrocardiogram monitoring during follow-up. A total of 130 patients underwent EACNA. Acute procedural success was achieved in 96.2% of the cases. During a median follow-up of 300 days (150, 496), the primary outcome occurred in 17/125 (14%) cases with acute procedural success (recurrence of AVB in 9 and new syncope in 8 cases). Operator experience and use of extracardiac vagal stimulation were similar for patients with and without primary outcomes. A history of atrial fibrillation, hypertension, and coronary artery disease was associated with a higher primary outcome occurrence. Only four patients with primary outcome required pacemaker placement during follow-up.

Conclusion: This is the largest multicentre study demonstrating the feasibility of EACNA with encouraging intermediate-term outcomes in selected patients with VAVB. Studies investigating the effect on burden of daytime symptoms caused by the AVB are required to confirm these findings.

Keywords: Ablation; Atrioventricular block; Bradycardia; Ganglionated plexus; Syncope.

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Conflict of interest statement

Conflict of interest: none declared.

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Survival analysis of the overall cohort with successful acute ablation.
Figure 2
Figure 2
Survival analysis of the overall cohort with successful acute ablation depending on the use of extracardiac vagal stimulation. P-value given by the log-rank test for the full follow-up length. ECVS, extracardiac vagal stimulation; HR, hazard ratio.
Figure 3
Figure 3
Survival analysis of the overall cohort with successful acute ablation depending on operator experience. P-value given by the log-rank test for the full follow-up length; HR, hazard ratio.
See this image and copyright information in PMC

Comment in

References

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