Right anterior ganglionated plexus: The primary target of cardioneuroablation?

  • Feng Hu
    Affiliations
    Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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  • Lihui Zheng
    Affiliations
    Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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  • Erpeng Liang
    Affiliations
    Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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  • Ligang Ding
    Affiliations
    Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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  • Lingmin Wu
    Affiliations
    Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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  • Gang Chen
    Affiliations
    Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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  • Xiaohan Fan
    Affiliations
    Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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  • Yan Yao
    Correspondence
    Address reprint requests and correspondence: Dr Yan Yao, Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China.
    Affiliations
    Cardiac Arrhythmia Center, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China
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      Background

      Catheter ablation of ganglionated plexus (GP) as cardioneuroablation in the left atrium (LA) has been used to treat vasovagal syncope (VVS).

      Objective

      The purpose of this study was to assess the effects of ablation of GPs on heart rate and to observe the acute, short-term, and long-term effects after cardioneuroablation.

      Methods

      A total of 115 consecutive patients with VVS who underwent cardioneuroablation were enrolled. GPs of the LA were identified by high-frequency stimulation and/or anatomic landmarks being targeted by radiofrequency catheter ablation.

      Results

      During ablation of right anterior ganglionated plexus (RAGP), heart rate increased from 61.3 ± 12.2 bpm to 82.4 ± 14.7 bpm (P <.001), whereas during ablation of other GPs only vagal responses were observed. During follow-up of 21.4 ± 13.1 months (median 18 months), 106 participants (92.2%) had no recurrence of syncope or presyncope. Holter data showed that minimal heart rate significantly increased at all follow-up time points (all P<.05), and mean heart rate remained higher than baseline 12 months after ablation (P = .001).

      Conclusion

      Cardioneuroablation via GP ablation in the LA effectively inhibited the recurrence of VVS. Ablation of RAGP could increase heart rate immediately and for the long term. This unique phenomenon may provide a new potential approach for treatment of neural reflex syncope or bradyarrhythmias.

      Keywords

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