Akademik Veri Yönetim Sistemi
AEPC 2022 - 55th Annual Meeting of the Association for European Paediatric and Congenital Cardiology , Geneve, İsviçre, 25 - 28 Mayıs 2022, ss.495-496
BACKGROUND AND AIM: In severe vasovagal syncopy (VVS) with long sinüs pauses or AV blocks,
back-up cardiac pacemaker therapy should be considered. Nowadays transcatheter
cardioneuroablation(CNA) is comming into prominance, especially in young patients. We present a
pediatric case successully treated with transcateheter CNA.
METHODS: CASE: A seventeen years old girl admitted to our clinic with frequent VVS attacks. 12-lead
ECG was normal. On 24-hour ambulatory-ECG frequent 2.degree mobitz-type-1 and 2:1 AV
blocks,and also advanced 2.degree AV blocks, up to 8,9 seconds of ventricular pause were detected.
Tread-mill exercise test and echocardiography revealed no pathology. During tilt testing the patient
had an type IIb cardioinhibitory type VVS with 8 second sinuse pause. Atropin challenge testing
revealed >30% increase in heart rate (from 75 bpm to 140 bpm). We decided to perform CNA.
The procedure was performed under general anesthesia.EnSite Precision 3-D mapping system
(EnSite Precision,Abbott, Chicago, Illinois) and limited floroscopy was used during procedure. After
transseptal puncture high density multipolar mapping catheter (Advisor HD Grid, Abbott, Chicago,
Illinois) through a 8,5f steerable long sheath (Agilis, Abbott, Chicago, Illinois) was used to mapp left
atrium, left- and right upper pulmonary vein (LUPV-RUPV) orifices, right atrium around superior vena
cava(SVC) for high amplitude fractional electrogram (HAFE) and low amplitude fractional
electrogram(LAFE) signals from epicardial parasympathic ganglions. Using an 8f contact-force
irrigated radiofrequency catheter (TactiCath, Abbott, Chicago, Illinois) lesions with 20-30 watt 34-
36ºC 107-110ohm and 8-10gram contact force were given to marked points, by following a 15%
decrease in impedance and until the HAFE and LAFE signals disappear, showing effectiveness of the
lesions. While a slow junctional rhythm developed during lesion delivery on LUPV, sinus tachycardia
was seen on RUPV, carina and SVC-right arial junction. After 24 lesions, each for 30 seconds, control
atropin challenge test was negative and the procedure was ended with success and without
complication.
RESULTS: Two weeks later, control Tilt testing and 24-hour ambulatory-ECG revealed normal results,
and the patient is still asymptomatic under follow-up after 3 months of ablation.
CONCLUSIONS: CNA is now an alternative treatment to cardiac pacemaker therapy in severe type IIb
cardioinhibitory type VVS, especially in selected young patients.