title: Simplified Cardioneuroablation in the Treatment of Reflex Syncope, Functional AV Block, and Sinus Node Dysfunction.
abstract: BACKGROUND
  Cardio neuroablation (CNA) is a lesser-known technique for management of patients with excessive vagal activation on the basis of radiofrequency catheter ablation (RFCA) of the areas related to the three main autonomic ganglia around the heart. We investigated the effectiveness of selective and/or stepwise RFCA of these areas via right atrium (RA) and/or left atrium (LA) in the patients with recurrent syncope due to excessive vagal activity.
  
  
  METHODS
  Twenty-two patients presenting symptomatic functional bradyarrhythmias, neurally mediated reflex syncope (NMS), symptomatic atrioventricular (AV) block, and symptomatic sinus node dysfunction (SND; number = 8, 7, 7, respectively) were enrolled. The three main paracardiac ganglia were targeted via RA and LA in the patients with NMS and SND. The procedure was performed via RA in the patients with AV block, followed by RFCA of all ganglia via LA, if AV conduction disorder persists. The sites showing fragmented potentials were identified by electrical mapping and verified by high-frequency stimulation and ablated until atrial electrical potential was completely eliminated (<0.1 mV).
  
  
  RESULTS
  The patients with NMS and SND were free from new syncopal episode at a mean 12.3 ± 3.4 months and 9.5 ± 3.1 months follow-up, respectively. Ablation from RA was successful in six of seven patients with AV block. Despite the increased heart rate, the resolution of AV block after the RFCA could not be achieved in one patient who had partial resolution with atropine infusion on admission.
  
  
  CONCLUSIONS
  CNA may be an alternative and safe strategy to reduce NMS episodes, and to treat functional AV block and symptomatic SND, especially in young patients.
authors.affiliation: Department of Cardiology, Derince Education and Research Hospital, Derince, Kocaeli, Turkey.
authors.forename: Tolga
authors.initials: T
authors.lastname: Aksu
authors.affiliation: Department of Cardiology, Derince Education and Research Hospital, Derince, Kocaeli, Turkey.
authors.forename: Ebru
authors.initials: E
authors.lastname: Golcuk
authors.affiliation: Cardiology Clinic, Bayrampasa Kolan Hospital, Istanbul, Turkey.
authors.forename: Kivanç
authors.initials: K
authors.lastname: Yalin
authors.affiliation: Department of Cardiology, Derince Education and Research Hospital, Derince, Kocaeli, Turkey.
authors.forename: Tümer Erdem
authors.initials: TE
authors.lastname: Guler
authors.affiliation: Department of Cardiology, Derince Education and Research Hospital, Derince, Kocaeli, Turkey.
authors.forename: Ismail
authors.initials: I
authors.lastname: Erden
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D054537:Atrioventricular Block / Q000175:diagnosis / Q000601:surgery*; D001919:Bradycardia / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D017115:Catheter Ablation / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000379:methods; D012804:Sick Sinus Syndrome / Q000601:surgery*; D013575:Syncope / Q000175:diagnosis / Q000601:surgery*; D016896:Treatment Outcome; D014630:Vagus Nerve / Q000601:surgery*; D055815:Young Adult
keywords: AV block; ablation; parasympathetic; sinus node dysfunction; syncope