Cardioneuroablation for pediatric patients with functional sinus node dysfunction and paroxysmal atrioventricular...

Area of Science:

• Pediatric Cardiology
• Electrophysiology
• Interventional Cardiology

Background:

• Pediatric bradycardia and syncope are common, usually benign.
• Rarely, prolonged sinus pauses (SP) or paroxysmal atrioventricular block (AVB) cause significant symptoms.
• Cardioneuroablation (CNA) targets autonomic input to the heart via ganglionated plexi ablation.

Purpose of the Study:

• To describe the methodology of CNA for pediatric SP or AVB.
• To evaluate the role of CNA in treating these conditions in children and adolescents.

Main Methods:

• Single-center case series of pediatric patients (≤21 years) undergoing CNA (2015-2021).
• CNA utilized anatomically guided and high-frequency stimulation techniques.
• Included patients with functional SP or AVB, some with prior syncope.

Main Results:

• Six patients (median age 18.9 years) with SP, AVB, or both were included.
• Pre-CNA, median longest pause was 8.9s; post-CNA, median longest pause was 1.3s at 3 months and 1.1s at 6 months.
• No syncope occurred post-CNA, with significant reduction in documented pauses.

Conclusions:

• CNA is a potentially effective treatment for pediatric syncope due to functional SP or AVB.
• It serves as an alternative to pacemaker implantation.
• CNA successfully disrupts vagal-mediated input causing these arrhythmias.