Pediatric radiofrequency ablation of cardiac parasympathetic ganglia to achieve vagal denervation

Figures

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  Figure 1. a: A 3.3-second period of high-grade atrioventricular (AV) block without ventricular escape on the patient's initial inpatient Holter monitor. b: High-grade AV block with a fascicular escape rhythm noted after 18 seconds from his implanted cardiac monitor. Vertical arrows refer to representative P waves that are not conducted.

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  Figure 2. Two examples of neurostimulation of the atrioventricular (AV) node parasympathetic ganglion delivered via the ablation catheter. a: Slowing of AV conduction during atrial fibrillation. b: Neurostimulation resulted in atrial tachycardia with marked PR prolongation. (NS depicts the duration of neurostimulation in each snapshot).

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  Figure 3. Three-dimensional CARTO (Biosense Webster, Diamond Bar, CA) maps depicting ablation lesions in the (a) anteroposterior (AP) projection and (b) left anterior oblique (LAO) and cranial projections. Outline of the right atrium (RA) is solid with some transparency. Left atrium (LA) is mesh. RA lesions are colored blue, while LA lesions are colored white, pink, or red. Yellow dots represent the area of the His bundle. The coronary sinus (CS) is colored purple, and the right inferior pulmonary vein (RIPV) is light blue.