Cardioneuroablation

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A frequent type of sycnope, termed vasovagal syncope is originated by intense cardioinhibition, mediated by a sudden vagal reflex, that causes transitory cardiac arrest by asystole and/or transient total atrioventricular block.[1][2] It is known as “Vaso-vagal Syncope”, “Neurocardiogenic Syncope” or “Neurally-mediated Reflex Syncope”.[3] Although many different therapies have been tried in this condition, severe and refractory cases have been treated with pacemaker implantation despite great controversies about its benefit.[4][5]

The “Cardioneuroablation” is a technique created in the nineties and patented in USA, aiming to eliminate the cardiac branch of vagal reflex in order to treat the neurocardiogenic syncope without pacemaker implantation.[6][7] It is performed without surgery, by using radiofrequency catheter ablation with one-day hospital.

The results up to 100 months follow-up are showing better outcome than clinical measures or pacemaker implantation with changing the tilt-test on to normal and by absence of syncope in more than 90% of patients without medications.[8][9]

References[edit]

  1. ^ Brignole, M, Alboni, P, Benditt, DG, et al. Guidelines on management (diagnosis and treatment) of syncope--update 2004. Europace 2004; 6:467.
  2. ^ Morillo CA; Eckberg DL; Ellenbogen KA; Beightol LA; Hoag JB; Tahvanainen KU; Kuusela TA; Diedrich - Vagal and sympathetic mechanisms in patients with orthostatic vasovagal syncope. Circulation 1997 Oct 21;96(8):2509-13.
  3. ^ Olshansky B - Pathogenesis and etiology of syncope - 2013 UpToDate – www.uptodate.com
  4. ^ Raviele A, Giada F, Menozzi C, et al. Vasovagal Syncope and Pacing Trial Investigators. A randomized, double-blind, placebo-controlled study of permanent cardiac pacing for the treatment of recurrent tilt-induced vasovagal syncope. The vasovagal syncope and pacing trial (SYNPACE). 1. Eur Heart J. 2004 Oct;25(19):1741-8.
  5. ^ Connolly SJ, Morillo C, et al. VPS II Study. JAMA. 2003 May 7;289(17):2224-9.
  6. ^ Pachon JC, Pachon EI, Pachon JC, Lobo TJ, Pachon MZ, Vargas RN, Jatene AD. "Cardioneuroablation"--new treatment for neurocardiogenic syncope, functional AV block and sinus dysfunction using catheter RF-ablation. Europace. 2005 Jan;7(1):1-13. PubMed PMID 15670960.
  7. ^ Pachon M JC, Pachon M EI, Lobo TJ, Pachon M JC, Pachon MZ, Vargas RN, Manrique RM, Jatene AD. Syncopal high-degree AV block treated with catheter RF ablation without pacemaker implantation. Pacing Clin Electrophysiol. 2006 Mar;29(3):318-22.
  8. ^ Pachon JC, Pachon EI, Cunha Pachon MZ, Lobo TJ, Pachon JC, Santillana TG. Catheter ablation of severe neurally meditated reflex (neurocardiogenic or vasovagal) syncope: cardioneuroablation long-term results. Europace. 2011 Sep;13(9):1231-42. doi: 10.1093/europace/eur163. Epub 2011 Jun 28. PubMed PMID 21712276.
  9. ^ Barón-Esquivias G, Errázquin F, Pedrote A, Cayuela A, Gómez S, Aguilera A, Campos A, Fernández M, Valle JI, Redondo M, Fernández JM, Martínez A, Burgos J, Martínez-Rubio A. - Long-term outcome of patients with vasovagal syncope. Am Heart J. 2004 May;147(5):883-9.