RESUMEN
Cardioneuroablation has emerged as a potential alternative to cardiac pacing in selected cases with vasovagal reflex syncope, extrinsic vagally induced sinus bradycardia-arrest or atrioventricular block. The technique was first introduced decades ago, and its use has risen over the past decade. However, as with any intervention, proper patient selection and technique are a prerequisite for a safe and effective use of cardioneuroablation therapy. This document aims to review and interpret available scientific evidence and provide a summary position on the topic.
Asunto(s)
Terapéutica , Síncope Vasovagal , Bloqueo Atrioventricular , Sistema Nervioso Autónomo , Síncope , Bradicardia , Selección de PacienteRESUMEN
Usando el mapeo espectral endocárdio en ritmo sinusal nosotros podemos definir dos tipos de miocardio auricular: el fibrilar con espectro segmentado hacia la derecha - llamado Nido-FA (NFA) - y el compacto con espectro no segmentado hacia la izquierda. Al inducir FA nosotros hemos observado constantemente activación muy desorganizada sobre los Nidos-FA [tejido resonante reactivo] mientras el compacto mantiene una activación bien regular [ tejido pasivo]. Ambos son activados por una taquicardia protegida de alta frecuencia "Taquicardia de Background" (TB). Describir el tratamiento de la FA a través de la ablación - RF de los Nidos-FA y la TB. 92 p (76 H, 52,4 ± 11 a) con FA refractaria muy frecuente, 56 paroxístina, 25 persistente, 11 permanente sin cardiopatía significativa (AI 41, 9 ± 5mm). 1- Ablación- RF con catéter de los NFA [4/8 mm-60°/30-40J/30s] guiado por mapeo espectral en ritmo sinusal fuera de las venas pulmonares (VP); 2- Estimulación auricular (300 ppm); 3- Adicional ablación de los NFA cuando era inducida FA; 4- Ablación de TB focal o Flutter cuando eran inducidos; 4 - Seguimiento Clínico SC (EKG/Holter). Una media de 50 ± 18 nidos-FA / p fueron tratados. Después de SC 0 11,3 ± 8 meses 81p (88%) no tenía FA (28,3 % previamente utilizaban drogas AA no eficaces). Después de ablación los NFA: fue imposible reinducir FA en 61p (71 %); en 31p (29%) solo FA no sostenida (< 10s) fue inducida; TB fue inducida y tratada en 24p (26%). Dos derrames pericárdicos ocurrieron (tratada en 24p (26%). Dos derrames pericárdicos ocurrieron (tratada en 24p (26%). Dos derrames pericárdicos ocurrieron (tratados 1 clínicamente y 1 quirúrgicamente) descrito utilizando una específica y no más usada vaina. El mapeo espectral de los Nidos - FA fue fácil de hallar y ablacionar; Durante la FA los Nidos _ FA juegan un papel resonante reactivo mientras el compacto juega un papel pasivo, uno o ambos son activados por la TB de elevada frecuencia; Después de la ablación de los...
Using endocardial spectral mapping in sinus rhythm we found two kinds of atrial myocardium: fibrillar with a rightward - segmented spectrum - named AF - Nest (AFN) - and compact with a leftward non - segmented spectrum. Inducing AF we have consistently observed very highly disorganized activation only in the AF - Nest [reactive resonant tissue] while the compact myocardium maintains well - organized, predominantly regular activation [passive tissue]. Both are activated by a high frequency protected tachycardia "Background Tachycardia" (BT). To describe treatment of AF by AF - Nests and BT catheter RF - ablation. 92 (76 males, 52.4 ± 11 y) with very frequent refractory AF, paroxysmal in 56, persistent in 25, and permanent in 11 without any significant cardiopathy (LA 41. 9 ± 5mm). 1 - AFN Catheter RF ablation [4/8mm - 60°/30-40J/30s] guided by spectral mapping in sinus rhythm outside the pulmonary veins (PV); 2 - Atrial stimulation (300ppm); 3 - AFN additional ablation if AF induced; 4 - BT focal or flutter ablation if induced; 4 - Clinical FU (EKG/Holter). A mean of 50 ± 18 AF nests/person were treated. After 11. 3 ± 8 months of follow up, 81 (88%) patients had no AF (28. 3 % previously on no effective AA drugs). After AFN ablations, it Was not possible to reinduce AF in 61 (71%) cases. In 31 patients (29 %) only non - sustained AF (< 10s) was induced; BT was induced and treated in 24 patientns (26%). Two pericardial effusions occurred (1 clinically and 1 surgically treated) related to an isolated cause and the other to a sheath no longer in use. Using spectral mapping, AF - Nests were easily found and ablated. During AF - Nests play a reactive resonant role while the compact myocardium plays a passive one, both activated by the high frequency BT. After AF - nest and BT ablations it was not possible to reinduce sustained AF; AF - nest and BT ablation around the PV is safe, feasible and very efficient for the cure or control of AF.
Asunto(s)
Humanos , Masculino , Femenino , Función Atrial , Ablación por Catéter/métodos , Arritmias Cardíacas/fisiopatología , Fibrilación Atrial/diagnóstico , Fibrilación Atrial/radioterapia , CardiologíaRESUMEN
Cardiac neuroablation is a new technique for management of patients with dominantly adverse parasympathetic autonomic influence. The technique is based on radiofrequency (RF) ablation of autonomic connections in the three main ganglia around the heart. Their connections are identified by Fast-Fourier Transforms (FFTs) of endocardial signals: sites of autonomic nervous connections show fractionated signals with FFTs shifted to the right. In contrast, normal myocardium without these connections does not show these features. RF-ablation is thought to inflict permanent damage on the parasympathetic autonomic influence because its cells are adjacent to the heart whereas sympathetic cells are remote. Twenty-one patients with a mean age of 48 years, neurally mediated reflex syncope in six, functional high grade atrioventricular block in seven and sinus node dysfunction in 13 (there is overlap between the second and third groups) were treated. Follow-up for a mean of 9.2 months demonstrated success in all cases with relief of symptoms. No complications occurred.