Author + information
- Received November 30, 2016
- Accepted December 15, 2016
- Published online March 29, 2017.
- aDepartment of Cardiology, Imeldaziekenhuis, Bonheiden, Belgium
- bThe Lambe Institute for Translational Medicine and Curam, National University of Ireland, Galway, Ireland
- cSaolta University Healthcare Group, Galway, Ireland
- ↵∗Address for correspondence:
Dr. Philippe Debruyne, Department of Cardiology, Imeldaziekenhuis, Imeldalaan 9, 2820 Bonheiden, Belgium.
- inappropriate sinus bradycardia
- neurally-mediated syncope
- sinus bradycardia
We have previously shown that neurally-mediated syncope and inappropriate sinus bradycardia can be treated by cardio-neuromodulation (CardNM), which is a selective and tailored ablation of the anterior right ganglionated plexus (ARGP) (1). In our first publication, the left-sided approach was described, and its rationale discussed. Five additional patients have now been treated by a right-sided approach. A circular multielectrode irrigated catheter (nMARQ; Biosense Webster, Diamond Bar, California) was positioned at the posteroseptal side of the junction between the right atrium and the superior vena cava facing the mid and caudal parts of the right superior pulmonary vein antrum (Figures 1A and 1B). In 1 of the patients (Figure 1C), we delivered a single radiofrequency application from the right atrium and completed CardNM from the left side, demonstrating the geographical match between the right and left ablation sites, sandwiching the ARGP. Ablation duration was <5 minutes per patient. The baseline P-P interval shortened along a sigmoid curve (r2 ≥ 0.98) by 310 ± 165 ms (mean ± SD) during CardNM (p = 0.028). We postulated that the first plateau of the curve reflected the time needed to reach an epicardial target. We allocated the steep part of the curve to lesion formation, whereas the second plateau was in line with the maximal volume of injury from a particular ablation site. There was a reduction in syncopes at 12-month follow-up (p = 0.035), and the shortening in P-P interval was maintained at 12 months (Figures 2A and 2B). The number of beats <50 beats/min tended to be reduced at 6-month follow-up (–9,847 beats/24 hours) (Figure 2C). CardNM as a treatment for neurally-mediated syncope and inappropriate sinus bradycardia is currently being evaluated in a larger trial (Second Study on Cardio-neuromodulation in Humans [CardNMH2]; NCT02954666).
Catheters and clinical support during procedures were kindly provided by Biosense Webster.
Dr. Debruyne has applied for a patent related to this research. Dr. Wijns is a Nonexecutive Board Member of Argonauts and Genae, and a past Board Member of Cardio3BioSciences (now Celyad).
- Received November 30, 2016.
- Accepted December 15, 2016.
- 2017 American College of Cardiology Foundation