Cardioneural ablation in a patient with spinal cord injury and significant sinus bradycardia

Figures

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  Figure 1. Sinus bradycardia and junctional bradycardia prior to the ablation. A: Sinus bradycardia with heart rate 27 beats/min. B: Junctional bradycardia on telemetry monitoring.

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  Figure 2. Electroanatomic maps of both atria displaying the radiofrequency application sites. A: Left anterior oblique (LAO) view of right and left atrium showing ablation lesion set. B: Posterior view of atria highlighting septal ablation in the right atrium (RA) with proximity to ablation on antrum of right superior pulmonary vein (RSPV). C: An example of induction of atrial fibrillation as well as R-R interval prolongation during high-frequency stimulation from the superior vena cava. D: An example of pronounced heart rate increase with ablation from the right atrial septum. Ao-SVCGP = aorta–superior vena cava ganglionated plexi; CS = coronary sinus; CS-OS = coronary sinus ostium; IVC = inferior vena cava; LSGP = left superior ganglionated plexi; RAGP = right anterior ganglionated plexi; RL = right lateral; SVC = superior vena cava.

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  Figure 3. Change in heart rate post ablation. A: Heart rate trend from initial hospitalization. Red dashed line denotes date of ablation with a subsequent increase in heart rate. B: Preprocedure electrocardiogram (ECG) showing sinus bradycardia. C: Heart rate trend and heart rate variability from heart rate monitor 10 months post procedure, showing a significant increase in heart rate and heart rate variability below the normal range. D: ECG 3 months post procedure showing sinus tachycardia.