Targets and End Points in Cardiac Autonomic Denervation Procedures

• DOI: 10.1161/circep.116.004638
• Publication Date: 2017-02-16T02:10:46Z
• Authors: Esteban W. Rivarola; Denise Hachul; Tan Wu; Cristiano Pisani; Carina Hardy; Fabrizio Raimundi; Sissy Melo; Francisco Darrieux; Mauricio Scanavacca
• Keywords: Sympathetic Denervation

Autonomic denervation is an alternative approach for patients with symptomatic bradycardia. No consensus exists on the critical targets and end points of procedure. The aim this study was to identify immediate atrial regions responsible vagal denervation.We enrolled 14 (50% men; age: 34.0±13.8 years) cardioinhibitory syncope, advanced atrioventricular block or sinus arrest, no structural heart disease. Anatomic mapping ganglionated plexuses performed, followed by radiofrequency ablation. Heart rate, node recovery time, Wenckebach cycle length, atrial-His (AH) interval were measured before after every pulse. Wilcoxon signed-rank test used comparison. Significant shortening R-R (P=0.0009), length AH intervals (P=0.0014) observed rate elevation 23.8±12.5%, 18.1±11% 24.6±19%, respectively. Atropine bolus injection (0.04 mg/kg) did not increase further. Targeting a single spot left side (64% patients) right (36%) interatrial septum be ≥80% final during ablation.Targeting specific sites in nodal conduction properties might attenuation. interval, shortening, associated negative response atropine, could considered