https://orcid.org/0000-0002-1866-0651
After extensive weight loss, a 30-year-old male patient suffered from highly symptomatic sinus bradycardia with dizziness, headache, and syncope. After intrinsic sinus node disease was ruled out, we decided to perform a cardioneuroablation (CNA) of the right anterior ganglionated plexus (RAGP) in order to increase his baseline sinus heart rate.
We used a prior computed tomography of the left atrium for anatomical guidance. It was merged with a three-dimensional activation map of the right atrium. Ablation was performed in the right atrium, facing the right superior pulmonary vein (blue dot, figure) and resulted in an immediate increase of heart rate from 48 to 71 b.p.m. and was thereafter stable at around 68 b.p.m. (+40% to baseline). After a waiting time of 20 min an Atropine challenge was performed. In contrast to the response before ablation, there was no relevant increase in heart rate, thus ablation was considered successful. During a 2-month follow-up, baseline heart rate remained increased with preserved rise in an exercise test and the patient was asymptomatic.
In summary, CNA of the RAGP proved to be a simple and effective mean to effectively treat symptomatic sinus bradycardia by inducing persistent vagolysis of the sinus node.
The full-length version of this report can be viewed at: https://www.escardio.org/Education/E-Learning/Clinical-cases/Electrophysiology.
