Springer Nature is making SARS-CoV-2 and COVID-19 research free. View research | View latest news | Sign up for updates

Medium-term results of cardioneuroablation for clinical bradyarrhythmias and vasovagal syncope: effects on QT interval and heart rate

Abstract

Purpose

Although parasympathetic effects of cardioneuroablation (CNA) in vagally mediated bradyarrhythmias (VMB) were studied, sympathetic effects have not been elucidated, yet. We aimed to investigate the acute and medium-term outcomes of CNA as well as the impact of CNA on ventricular repolarization by using corrected QT interval (QTc) measurements.

Methods

Sixty-five patients (58.5% men; age 39.4 ± 14 years) undergoing CNA were included in the study. Patients who underwent CNA due to VMB were divided into two groups: (1) bi-atrial CNA and (2) right-sided CNA. QTc was calculated at 3 time points: before the procedure (time point 1); 24 h post-ablation (time point 2); and at the last follow-up visit (time point 3).

Results

The mean follow-up time was 20.0 ± 20 months. Acute success was achieved in 64 (98.4%) of cases. In the whole cohort, from time point 1 to 2, a significant shortening in QTcFredericia, QTcFramingham, and QTcHodges was observed which remained lower than baseline in time point 3. Although the difference between measurements in time point 1 and 2 was not statistically significant for QTcBazett, a significant shortening was detected between time point 1 and 3. There was significant difference between groups for shortening in QTcFredericia and QTcFramingham (p = 0.01). Event-free survival was detected in 90.7% (59/65) of cases.

Conclusions

Our results demonstrate a significant shortening of QTc in addition to high acute and medium-term success rates after CNA. The most likely mechanism is the effect of CNA on the sympathetic system as well as on the parasympathetic system. Bi-atrial ablation was found related to higher QTc shortening effect.

This is a preview of subscription content, log in to check access.

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7
Fig. 8

References

  1. 1.

    Aksu T, Guler TE, Yalin K, Mutluer FO, Ozcan KS, Calò L. Catheter ablation of bradyarrhythmia: from the beginning to the future. Am J Med Sci. 2018;355:252–65.

  2. 2.

    Aksu T, Güler TE, Mutluer FO, Oto MA. Vagal denervation in atrial fibrillation ablation: a comprehensive review. Anatol J Cardiol. 2017;18:142–8.

  3. 3.

    Hanna P, Rajendran PS, Ajijola OA, Vaseghi M, Andrew Armour J, Ardell JL, et al. Cardiac neuroanatomy - imaging nerves to define functional control. Auton Neurosci. 2017;207:48–58.

  4. 4.

    Chiou CW, Eble JN, Zipes DP. Efferent vagal innervation of the canine atria and sinus and atrioventricular nodes. The third fat pad. Circulation. 1997;95:2573–84.

  5. 5.

    Pachon JC, Pachon EI, Pachon JC, Lobo TJ, Pachon MZ, Vargas RN, et al. “Cardioneuroablation”—new treatment for neurocardiogenic syncope, functional AV block and sinus dysfunction using catheter RF-ablation. Europace. 2005;7:1–13.

  6. 6.

    Aksu T, Golcuk E, Yalin K, Guler TE, Erden I. Simplified cardioneuroablation in the treatment of reflex syncope, functional AV block, and sinus node dysfunction. Pacing Clin Electrophysiol. 2016;39:42–53.

  7. 7.

    Debruyne P, Rossenbacker T, Collienne C, Roosen J, Ector B, Janssens L, et al. Unifocal right-sided ablation treatment for neurally mediated syncope and functional sinus node dysfunction under computed tomographic guidance. Circ Arrhythm Electrophysiol. 2018;11:e006604.

  8. 8.

    Hu F, Zheng L, Liang E, Ding L, Wu L, Chen G, et al. Right anterior ganglionated plexus: the primary target of cardioneuroablation? Heart Rhythm. 2019;16(10):1545–51.

  9. 9.

    Wu B, Xu S, Dai R, Hong M, Wu H, Lin R. Epicardial ganglionated plexi ablation increases the inducibility of ventricular tachyarrhythmias in a canine postmyocardial infarction model. J Cardiovasc Electrophysiol. 2019. https://doi.org/10.1111/jce.13912.

  10. 10.

    Brignole M, Menozzi C, Del Rosso A, Costa S, Gaggioli G, Bottoni N, et al. New classification of haemodynamics of vasovagal syncope: beyond the VASIS classification. Analysis of the presyncopal phase of the tilt test without and with nitroglycerin challenge. Vasovagal Syncope Int Stud Europace. 2000;2:66–76.

  11. 11.

    Aksu T, Guler TE, Mutluer FO, Bozyel S, Golcuk SE, Yalin K. Electroanatomic-mapping-guided cardioneuroablation versus combined approach for vasovagal syncope: a cross-sectional observational study. J Interv Card Electrophysiol. 2019;54:177–88.

  12. 12.

    Al-Khatib SM, Stevenson WG, Ackerman MJ, Bryant WJ, Callans DJ, Curtis AB, et al. 2017 AHA/ACC/HRS guideline for management of patients with ventricular arrhythmias and the prevention of sudden cardiac death: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines and the HeartRhythm society. Heart Rhythm. 2018;15:e73–e189.

  13. 13.

    He B, Lu Z, He W, Wu L, Cui B, Hu X, et al. Effects of ganglionated plexi ablation on ventricular electrophysiological properties in normal hearts and after acute myocardial ischemia. Int J Cardiol. 2013;168:86–93.

  14. 14.

    Swissa M, Zhou SM, Gonzalez-Gomez I, Chang CM, Lai AC, Cates AW, et al. Long-term subthreshold electrical stimulation of the left stellate ganglion and a canine model of sudden cardiac death. J Am Coll Cardiol. 2004;43:858–64.

  15. 15.

    Li C, Hu D, Shang L, Ma S, Liu W, Li Y, et al. Surgical left cardiac sympathetic denervation for long QT syndrome: effects on QT intervaland heart rate. Heart Vessel. 2005;20:137–41.

  16. 16.

    Armour JA, Murphy DA, Yuan BX, Macdonald S, Hopkins DA. Gross and microscopic anatomy of the human intrinsic cardiac nervous system. Anat Rec. 1997;247:289–98.

  17. 17.

    Crick SJ, Anderson RH, Ho SY, Sheppard MN. Localisation and quantitation of autonomic innervation in the porcine heart II: endocardium, myocardium and epicardium. J Anat. 1999;195:359–73.

  18. 18.

    Pachon JC, Pachon EI, Pachon MZC, Lobo TJ, Pachon JC, Santillana TG. Catheter ablation of severe neurally meditated reflex (neurocardiogenic or vasovagal) syncope: cardioneuroablation long-term results. Europace. 2011;13:1231–42.

  19. 19.

    Zhao L, Jiang W, Zhou L, Wang Y, Zhang X, Wu S, et al. Atrial autonomic denervation for the treatment of long-standing symptomatic sinus bradycardia in non-elderly patients. J Interv Card Electrophysiol. 2015;43:151–9.

  20. 20.

    Rivarola EW, Hachul D, Wu T, Pisani C, Hardy C, Raimundi F, et al. Targets and end points in cardiac autonomic denervation procedures. Circ Arrhythm Electrophysiol. 2017;10:e004638.

  21. 21.

    Scanavacca M, Pisani CF, Hachul D, Lara S, Hardy C, Darrieux F, et al. Selective atrial vagal denervation guided by evoked vagal reflex to treat patients with paroxysmal atrial fibrillation. Circulation. 2006;114:876–85.

  22. 22.

    Pokushalov E, Romanov A, Shugayev P, Artyomenko S, Shirokova N, Turov A, et al. Selective ganglionated plexi ablation for paroxysmal atrial fibrillation. Heart Rhythm. 2009;6:1257–64.

Download references

Acknowledgments

We thank Burak Turan, MD (Kocaeli Derince Training and Research Hospital) and Halil Ibrahim Tanboga, MD (Hisar Hospital) for performing the statistical analysis of the study.

Author information

Correspondence to Tolga Aksu.

Ethics declarations

Conflict of interest

The authors declare that there is no conflict of interest.

Additional information

Publisher’s note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

ESM 1

(DOC 5403 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Aksu, T., Guler, T.E., Bozyel, S. et al. Medium-term results of cardioneuroablation for clinical bradyarrhythmias and vasovagal syncope: effects on QT interval and heart rate. J Interv Card Electrophysiol (2020). https://doi.org/10.1007/s10840-020-00704-2

Download citation

Keywords

  • QT interval
  • Atrial fibrillation
  • Syncope
  • Atrioventricular block
  • Bradycardia
  • Ganglionated plexi