Unifocal Right-Sided Ablation Treatment for Neurally Mediated Syncope and Functional Sinus Node Dysfunction Under...

Area of Science:

• Electrophysiology
• Cardiology
• Neuromodulation

Background:

• Previous extensive ablation strategies for neurally mediated syncope, sinus node dysfunction, and AV block exist.
• A novel, less extensive approach called cardio-neuromodulation has been developed.
• This method involves tailored vagolysis of the sinoatrial node via partial ablation of the anterior right-ganglionated plexus.

Purpose of the Study:

• To evaluate the safety and efficacy of cardio-neuromodulation for treating syncope.
• To assess the impact of cardio-neuromodulation on heart rate regulation and syncope recurrence.

Main Methods:

• Twenty patients with syncope were enrolled and divided into two groups based on diagnostic criteria (positive head-up tilt test or pauses ≥3 seconds).
• Cardio-neuromodulation was performed using a right-sided approach, guided by computed tomographic scans for targeted ablation.
• 24-hour rhythm monitoring and syncope burden assessments were conducted at baseline and follow-up intervals (1, 3, and 6 months).

Main Results:

• All patients experienced significant P-P interval shortening (>120 ms) after initial radiofrequency application, with a mean reduction of 219±160 ms (P<0.001).
• The procedure involved a mean ablation time of 7±4 minutes and an ablated surface area of 11±6 mm².
• A 100% reduction in beats <50/min and a 95% reduction in syncope burden were observed at 6-month follow-up (P<0.001).

Conclusions:

• Cardio-neuromodulation, utilizing a CT-guided, right-sided approach, is a safe and effective treatment.
• The procedure is fast, highly reproducible, and significantly prevents inappropriate functional sinus bradycardia.
• This technique demonstrates substantial success in preventing syncope recurrence.