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Idiopathic Ventricular Premature Contraction (VPC) is currently more routinely referred for electrophysiology evaluation. Usually it carries a good prognosis but, when symptomatic or suspected to produce ventricular dysfunction, will require treatment. Nowadays, RF ablation has great advantages over antiarrhythmic drugs. Classically the outflow tract (right or left), with the typical inferior axis with left (eventually right) bundle brunch block like ECG morphology, is considered the most frequent site of origin for idiopathic VPC, but with the widespread of EP procedures and advancement of technology making possible to map and ablate difficult locations, it is possible to see a growing and changing population referred for idiopathic VPC ablation, displaying that, almost any region of the heart may be source of this kind of arrhythmia that can be successfully treated. A well-planned procedure, with the presumed region of origin settled and employing the current technology and knowledge (tips), will have a high chance of cure. [ABSTRACT FROM AUTHOR]

Background: Cardioneuroablation (CNA) is a novel therapeutic approach for functional bradyarrhythmias, specifically neurocardiogenic syncope or atrial fibrillation, achieved through endocardial radiofrequency catheter ablation of vagal innervation, obviating the need for pacemaker implantation. Originating in the nineties, the first series of CNA procedures was published in 2005. Extra‐cardiac vagal stimulation (ECVS) is employed as a direct method for stepwise denervation control during CNA. Objective: This study aimed to compare the long‐term follow‐up outcomes of patients with severe cardioinhibitory syncope undergoing CNA with and without denervation confirmation via ECVS. Method: A cohort of 48 patients, predominantly female (56.3%), suffering from recurrent syncope (5.1 ± 2.5 episodes annually) that remained unresponsive to clinical and pharmacological interventions, underwent CNA, divided into two groups: ECVS and NoECVS, consisting of 34 and 14 cases, respectively. ECVS procedures were conducted with and without atrial pacing. Results: Demographic characteristics, left atrial size, and ejection fraction displayed no statistically significant differences between the groups. Follow‐up duration was comparable, with 29.1 ± 15 months for the ECVS group and 31.9 ± 20 months for the NoECVS group (p =.24). Notably, syncope recurrence was significantly lower in the ECVS group (two cases vs. four cases, Log Rank p =.04). Moreover, the Hazard ratio revealed a fivefold higher risk of syncope recurrence in the NoECVS group. Conclusion: This study demonstrates that concluding CNA with denervation confirmation via ECVS yields a higher success rate and a substantially reduced risk of syncope recurrence compared to procedures without ECVS confirmation. [ABSTRACT FROM AUTHOR]

Background: Despite good results, atrial fibrillation (AF) ablation shows a relatively high recurrence rate. Therefore, we sought to verify whether endocardial denervation by cardioneuroablation (CNA) can change the AF recurrence post-pulmonary vein isolation (PVI). Objective: To compare the long-term AF recurrence post-PVI versus PVI, plus vagal denervation (PVI+CNA) by CNA with vagal denervation confirmation by extracardiac vagal stimulation (ECVS). Methods: Case-control study of 127 patients, 104 (81.9%) males, 53.7 ± 12 years-old, with paroxysmal 71 (55.9%) or persistent 56 (44.1%) symptomatic AF, refractory to medications without cardiopathy, LA = 39.8 ± 6.8, EF = 0.66 ± 0.55. Two equivalent groups were established: PVI alone (55 cases) and PVI+CNA (72 cases). The ECVS was performed by intravenous catheter, near the jugular foramen with 50Hz/50microsec/1V/Kg/up to 70V. Endocardial CNA was biatrial over the four main ganglionated plexus and in the AF-Nests regions tagged by fractionation software. The endpoint of CNA was the elimination of the vagal effect induced by ECVS. Results: PVI was achieved in all cases. ECVS effectively induced a vagal reaction in all PVI+CNA patients, and it was possible to eliminate the vagal effect in 88.9% of cases. In 11.1% of cases, there was a slight residual vagal response. Patients were followed up to 45 months (mean FU = 21.4 ± 14.2 and 20.4 ± 14.3 months). Recurrences were 17 in the PVI group, and four in the PVI+CNA group: Log-Rank p < 0.00, HR: 5.38 (1.78-16.29, p = 0.003). No major complications occurred. Conclusion: Addition of vagal denervation to PVI, with validation of the vagal denervation by ECVS, significantly increased the success rate of the PVI with a marked reduction in AF relapses without increasing complications. [ABSTRACT FROM AUTHOR]

Background: Carotid sinus syndrome (CSS) is a condition caused by sudden autonomic nervous system imbalance with vagal overactivity. It may lead to sinus bradycardia, sinus arrest, and AV block with severe symptoms and syncope, which may be treated with a pacemaker (PM). Cardioneuroablation (CNA) is an atrial endocardial catheter radiofrequency (RF) ablation aiming vagal denervation that could be used to remove the cardioinhibitory response in the CSS as suggested in the original study. Objective: To study the outcome of CNA controlled by extracardiac vagal stimulation (ECVS) in patients with CSS without significant cardiopathy. Methods: Prospective, controlled study of eight patients with symptomatic CSS, positive carotid sinus massage (CSM), and normal atropine response. Bi-atrial RF-ablation of the neuro endo-myocardial interface was guided by filtered endocardial electrograms, fractionation, and 3D anatomical mapping, identifying AF-Nests (AFN) related to the four main ganglionic plexuses (GP) with bi-atrial RF ablation (irrigated catheter 30W/42°C/20-60s). ECVS (5s) at the left jugular foramen and CSM was performed before, during, and at the end of the ablation to guide the level of denervation, defining the higher CNA effect and end of the procedure, analyzing pauses and AVB, induced by ECVS and CSM. Results: The mean age of patients was 58.6 (± 11.8). Pre-CNA, CSM, and ECVS responses were asystole and transient AVB in all patients. Post-CNA, ECVS, and Atropine responses were completely abolished in seven out of eight patients. In a 31 ± 16.1 months follow up, one case with incomplete CNA experienced syncope recurrence due to AVB and was submitted to a new CNA for AVB becoming asymptomatic. Another case had a positive CSM six months after CNA and had a pacemaker (PM) implanted even though asymptomatic, as per his physician's discretion. There was immediate sustained HR (58.9 ± 12,7/81,8 ± 4.9 bpm) and Wenckebach's point increase (133.5 ± 39.2 / 164.7 ± 10.8ppm), p: < 0,01. Conclusion: Complete bi-atrial CNA vagal denervation, based on AFN/GP ablation guided by vagal effect abolishment confirmed by ECVS and CSM responses, was effective in eliminating syncope recurrence in all patients with CSS. [ABSTRACT FROM AUTHOR]

A 23-year-old-female patient had undergone a very successful gastric banding surgery to treat obesity. Six months later she began to present recurrent syncope due to very frequent, intermittent high-degree AV block referred to as pacemaker implantation. The electrophysiological study showed impaired AV nodal conduction but the His-Purkinje conduction was preserved. Partial catheter radiofrequency ablation of the cardiac autonomic nervous system guided by spectral endocardial mapping ( cardioneuroablation) was performed. The electrophysiological parameters were normalized. Holter recordings were normal and the patient was asymptomatic with normal life without pacemaker implantation in a follow-up 21 months later. [ABSTRACT FROM AUTHOR]