Cardioneuroablation for carotid sinus syndrome mediated by complete atrioventricular block

Figures

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  FIGURE 1. Intracardiac recordings obtained at the onset of the carotid sinus massage. The figure depicts three surface electrocardiogram recordings (DII, AVF, and V6) and recordings from a diagnostic catheter inside the coronary sinus (CSD, CS34, and CS78). At the onset, sinus node slows down, albeit without sinus pause and there is complete atrioventricular block which recovers after carotid sinus massage is stopped.

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  FIGURE 2. Electroanatomic maps of the left (anterior view) and right (posterior view) atria as well as ablation targets. We have targeted all major parasympathetic ganglia including ganglia located posterior to the coronary sinus which is the major efferent input into the atrioventricular node. Radiofrequency ablation was performed with power set to 30–35 W for at least 30 seconds. Red tags depicted on the figures are automatic ablation tags color‐coded by impedance drop (VisiTag, Carto 3, Biosense‐Webster, Diamond Bar, CA, USA). Pulmonary vein anterior antrums are marked by blue tags. At the end of the procedure, there was no vagal response to carotid sinus massage. CS, coronary sinus; LIPV, left inferior pulmonary vein; LUPV, left superior pulmonary vein; RIPV, right inferior pulmonary vein; RUPV, right superior pulmonary vein; SVC, superior vena cava.