Efficacy of cardioneuroablation for vasodepressor vasovagal syncope

Figures

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  Figure 1. Schematic representation of the distribution of the autonomic ganglionated plexus in the left atrium of a patient with mixed VVS. The left superior GP (LSGP) is located at the anterolateral junction of the left superior pulmonary vein and left atrium. The left inferior GP (LIGP) is located in the posterior inferior region of the junction between the left inferior pulmonary vein and the left atrium. The posteromedial left GP (PMLGP) is in the posterior atrial septum, between the left atrial posterior wall, inferior vena cava, and coronary sinus opening. The right anterior GP (RAGP) is in the anterior region of the junction between the right superior pulmonary vein and the left atrium. The right inferior GP (RIGP) is in the anterior region of the junction between the right inferior pulmonary vein and the left atrium (Left, posterior anterior position of heart; Right, anteroposterior position of heart).

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  Figure 2. Schematic representation of the distribution of the autonomic ganglionated plexus in the left atrium of a patient with vasodepressor VVS. The left superior GP (LSGP) is located at the anterolateral junction of the left superior pulmonary vein and left atrium. The left inferior GP (LIGP) is located in the posterior inferior region of the junction between the left inferior pulmonary vein and the left atrium. The posteromedial left GP (PMLGP) is in the posterior atrial septum, between the left atrial posterior wall, inferior vena cava, and coronary sinus opening. The right anterior GP (RAGP) is in the anterior region of the junction between the right superior pulmonary vein and the left atrium. The right inferior GP (RIGP) is in the anterior region of the junction between the right inferior pulmonary vein and the left atrium (Left, posterior anterior position of heart; Right, anteroposterior position of heart).

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  Figure 3. Schematic representation of cardiac ganglionated plexus ablation in a patient with VVS. Illustration of the vagal response induced by radiofrequency energy delivery at the RIGP. The geometry of the left atrium was constructed using the Ensite Navx mapping system. The blue balls represent the ablated lesions with a positive vagal response at each GP site. The green dots represent the real-time shadow of the catheter tip on the left atrial geometry. Radiofrequency ablation at the LSGP induced sinus arrest lasting 2,400 ms.

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  Figure 4. Comparison of the frequency of positive vagal reaction during GPs ablation. In both mixed and vasodepressor VVS, vagal responses were most frequently observed at the LSGP and RAGP.

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  Figure 5. Kaplan–Meier curve of recurrent syncope in patients with Vascular inhibitory and mixed VVS after CNA.