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Selective Vagal Denervation of the Sinus and Atrioventricular Nodes, Guided by Vagal Reflexes Induced by High Frequency Stimulation, to Treat Refractory Neurally Mediated Syncope
Author(s) -
SCANAVACCA MAURICIO,
HACHUL DENISE,
PISANI CRISTIANO,
SOSA EDUARDO
Publication year - 2009
Publication title -
journal of cardiovascular electrophysiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.193
H-Index - 138
eISSN - 1540-8167
pISSN - 1045-3873
DOI - 10.1111/j.1540-8167.2008.01385.x
Subject(s) - medicine , denervation , anesthesia , atrioventricular node , reflex , asymptomatic , cardiology , ablation , vagus nerve , refractory period , vagovagal reflex , refractory (planetary science) , stimulation , tachycardia , physics , astrobiology
A 15‐year‐old female patient presented with frequent episodes of vasovagal syncope refractory to non‐pharmacological and pharmacological measures. Two tilt‐table tests performed before and after conventional therapy were positive and reproduced the patient's clinical symptoms. Selective vagal denervation, guided by HFS, was performed. Six radiofrequency pulses were applied on the left and right sides of the interatrial septum, abolishing vagal responses at these locations. Basal sinus node and Wenckebach cycle lengths changed significantly following ablation. A tilt test performed after denervation was negative and revealed autonomic tone modification. The patient reported significant improvement in quality of life and remained asymptomatic for 9 months after denervation. After this period, three episodes of NMS occurred during a 4‐month interval and a tilt test performed 11 months after the procedure demonstrated vagal activity recovery.