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Anatomic guided ablation of the atrial right ganglionated plexi is enough for cardiac autonomic modulation in patients with significant bradyarrhythmias
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  • Dinis MesquitaOrcid,
  • Leonor ParreiraOrcid,
  • Pedro Carmo,
  • Rita Marinheiro,
  • Diogo Cavaco,
  • Pedro Amador,
  • Elisabete Vaz,
  • Francisco Costa,
  • José Farinha,
  • Mauricio Ibrahim Scanavacca,
  • Rui Caria,
  • Pedro Adragão
Dinis Mesquita
Orcid
Hospital de S. Bernardo, Centro Hospitalar de Setúbal E.P.E.
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Leonor Parreira
Orcid
Hospital de S. Bernardo, Centro Hospitalar de Setúbal E.P.E.
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Pedro Carmo
Hospital de St.ª Cruz, Centro Hospitalar de Lisboa Ocidental E.P.E.
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Rita Marinheiro
Hospital de S. Bernardo, Centro Hospitalar de Setúbal E.P.E.
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Diogo Cavaco
Hospital de St.ª Cruz, Centro Hospitalar de Lisboa Ocidental E.P.E.
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Pedro Amador
Hospital de S. Bernardo, Centro Hospitalar de Setúbal E.P.E.
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Elisabete Vaz
Hospital de St.ª Cruz, Centro Hospitalar de Lisboa Ocidental E.P.E.
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Francisco Costa
Hospital de St.ª Cruz, Centro Hospitalar de Lisboa Ocidental E.P.E.
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José Farinha
Hospital de S. Bernardo, Centro Hospitalar de Setúbal E.P.E.
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Mauricio Ibrahim Scanavacca
Hospital de St.ª Cruz, Centro Hospitalar de Lisboa Ocidental, E.P.E.
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Rui Caria
Hospital de S. Bernardo, Centro Hospitalar de Setúbal E.P.E.
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Pedro Adragão
Hospital de St.ª Cruz, Centro Hospitalar de Lisboa Ocidental E.P.E., EP Centre Cardiology, Hospital de Santa Cruz
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Abstract

Introduction: Cardiac autonomic system modulation by endocardial ablation targeting atrial ganglionated plexi (GP) is an alternative strategy in selected patients with severe functional bradyarrhythmias, although no consensus exists on the best ablation strategy. The aim of this study was to evaluate if a simplified approach by a purely anatomical guided ablation of just the atrial right GP is enough for the treatment of these patients. Methods: We prospectively enrolled patients with significant functional bradyarrhythmias and performed endocardial ablation purely guided by 3D electroanatomic mapping directed at the atrial right GP and accessed parameters of parasympathetic modulation and recurrence of bradyarrhythmias. Results: Thirteen patients enrolled (76.9% male, median age 51, 42-63 years). After ablation, a median RR interval shortening of 28.3 (25.6–40.3)% occurred (111, 937.5-1395.4ms to 722.9, 652.2-882.4ms, p=0.0015). The AH interval also shortened (19, 10.5–35.7%) significantly after the procedure (115, 105-122ms to 85, 71-105ms, p=0.002) as well as Wenckebach cycle length (11.1, 5.9–17.8% shortening) from 450, 440-510ms to 430, 400-460ms, p=0.0014. On 24-hour Holter monitoring there was significant increase in heart rates (HR) of patients after ablation (minimal HR increased from 34 (26-43)bpm to 49 (43–56)bpm, p=0,0063 and mean HR from 65 (47-72)bpm to 78 (67-87)bpm, p=0.0015). No patients had recurrence of symptoms or significant bradyarrhythmias during a median follow-up of 8.4 months. Conclusions: A purely anatomic guided procedure directed only at the atrial right ganglionated plexi seems to be enough as a therapeutic approach for cardiac parasympathetic modulation in selected patients with significant functional bradyarrhythmias.