Turk Kardiyol Dern Ars. Ahead of Print: TKDA-15163 | DOI: 10.5543/tkda.2017.15163
A new and simple technique for vagal ganglia ablation in a patient with functional atrioventricular block: Electroanatomical approach
, Tumer Erdem Guler1
, Kivanc Yalin2
, Serdar Bozyel1
, Ferit Onur Mutluer31
University of Health Sciences, Kocaeli Derince Education and Research Hospital, Department of Cardiology, Kocaeli/Turkey2
University of Usak, Faculty of Medicine, Department of Cardiology, Uşak/Turkey3
Koc University Hospital, Department of Cardiology, Istanbul/Turkey
Increased parasympathetic tone may cause symptomatic functional atrioventricular block (AVB) and necessitate pacemaker implantation. In these patients, where there is no structural damage to the conduction system, removal of the vagal activity by radiofrequency ablation seems to be a theoretically rational method. Until now, different methods have been used to determine suitable areas for vagal ganglia ablation. We aimed to describe a new method detecting parasympathetic innervations sites without the need to use additional equipment or extending the procedure times.Keywords:
A 51-year-old man was referred to our clinic for implantation of a permanent pacemaker because of symptomatic second degree AVB and recurrent syncope. Functional nature of AVB and supra-Hisian location was verified with standard ECGs, Holter recordings, atropine sulfate test and standard electrophysiological study, respectively. Using conventional recordings, electrograms were divided 3 subgroups and the sites demonstrating fractionated pattern were targeted. Being suitable for usual ganglion settlement, all fractionated electrograms were ablated.
The procedure was firstly started from left atrial side and then continued with right atrial ablation. During left atrial ablation, intrinsic basic cycle length of sinus node accelerated to 800 ms despite of AVB persistence. Then, 1: 1 atrioventricular conduction was achieved when ablation was applied around coronary sinus ostium. The patient has been completely asymptomatic, experiencing no episodes of dizziness or syncope and taking no medications at the end of 9-month follow-up.
In conclusion, electroanatomical guided vagal ganglia ablation may be a good alternative to pacemaker implantation in the well selected patients with functional AVB.
Parasympathetic, atrial fibrillation, bradicardia, syncope, sinus node, atrioventricular node
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Corresponding Author: Tolga Aksu, Türkiye