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Long-Term Outcome of Cardiac Denervation Procedures: The Anatomically Guided Septal Approach.

Esteban W R Rivarola1, Denise Hachul1, Tan Chen Wu1

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Ganglionated plexus ablation effectively treats functional bradycardia by denervating cardiac autonomic nerves, preventing syncope in most patients long-term. This cardiac denervation avoids pacemaker implantation for many individuals.

Keywords:
ablationautonomic nervous systembradycardiacardioneuroablationsyncope

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Area of Science:

  • Cardiology
  • Electrophysiology
  • Autonomic Nervous System

Background:

  • Functional bradycardia affects healthy individuals and can be challenging to manage.
  • Ganglionated plexus ablation offers a therapeutic alternative to pacemaker implantation.
  • Understanding the long-term effects of cardiac autonomic denervation is crucial.

Purpose of the Study:

  • To evaluate the long-term efficacy and safety of anatomically guided cardiac denervation for functional bradycardia.
  • To assess the impact of ablation on heart rate regulation and autonomic function.

Main Methods:

  • A prospective longitudinal study involving 36 patients with symptomatic functional bradycardia.
  • Electroanatomic mapping of both atria to locate and target main septal ganglionated plexi.
  • Ablation endpoints included heart rate increment, Wenckebach cycle length shortening, and atrio-Hisian interval shortening.

Main Results:

  • Successful sinus node denervation achieved in all patients, with a significant heart rate increase (21.6%).
  • 83.3% of patients remained event-free after a mean follow-up of 52.1 months.
  • No significant proarrhythmia effects were observed during long-term follow-up.

Conclusions:

  • Anatomically guided septal ablation is effective for syncope prevention in functional bradycardia.
  • The procedure promotes long-lasting autonomic changes with a favorable safety profile.
  • This technique provides a viable alternative to pacemakers for managing symptomatic bradycardia.