title: Atrial autonomic denervation for the treatment of long-standing symptomatic sinus bradycardia in non-elderly patients.
abstract: OBJECTIVE
  Multiple lead and generator replacement and related complications often complicate the decision of pacemaker implantation in non-elderly patients with symptomatic bradycardia. This study sought to investigate the efficacy and safety of atrial autonomic denervation for treating the symptomatic long-standing sinus bradycardia (SB) in non-elderly patients.
  
  
  RESULTS
  Eleven non-elderly patients (mean age, 45.9 ± 10.9 years; eight men) with a long history of SB (106.2 ± 43.7 months; range, 60-189) were enrolled. Five atrial ganglionated plexies (GPs), identified by anatomic distribution and high-frequency stimulation, were targeted and ablated. The end point was elimination of the vagal response at ablation sites. The symptoms of SB and Holter were followed up at 3 days, 6, and 12 months and, thereafter, over a period of 18 months. Six patients were under 50 years old (group I) and 5 patients were between 50 and 60 years old (group II). There were 3.1 ± 0.7 GPs with positive vagal response and 11.3 ± 2.7 ablation sites in each patient. During the 18.4 ± 6.2 (range, 12-25) months of follow-up, all patients reported significant symptom improvement with a significant decrease of the SB-related symptoms score. The total heartbeats, mean, and minimum heart rate significantly increased that persisted for 12 months. Compared with patients in group II, those in group I had more increases in total heartbeats and mean heart rate (HR).
  
  
  CONCLUSIONS
  Atrial autonomic denervation increases sinus rate and improves symptoms in non-elderly patients with symptomatic long-standing SB, thus, potentially serving as an alternative to pacemaker implantation.
authors.affiliation: Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiaotong University, 241 West Huaihai Road, Shanghai, 200030, China.
authors.forename: Liang
authors.initials: L
authors.lastname: Zhao
authors.forename: Weifeng
authors.initials: W
authors.lastname: Jiang
authors.forename: Li
authors.initials: L
authors.lastname: Zhou
authors.forename: Yuanlong
authors.initials: Y
authors.lastname: Wang
authors.forename: Xiaodong
authors.initials: X
authors.lastname: Zhang
authors.forename: Shaohui
authors.initials: S
authors.lastname: Wu
authors.forename: Kai
authors.initials: K
authors.lastname: Xu
authors.forename: Xu
authors.initials: X
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D000328:Adult; D017763:Autonomic Denervation / Q000379:methods*; D001919:Bradycardia / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D004562:Electrocardiography; D005260:Female; D006325:Heart Atria / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome