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Atrial autonomic denervation for the treatment of long-standing symptomatic sinus bradycardia in non-elderly patients

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Abstract

Purpose

Multiple lead and generator replacement and related complications often complicate the decision of pacemaker implantation in non-elderly patients with symptomatic bradycardia. This study sought to investigate the efficacy and safety of atrial autonomic denervation for treating the symptomatic long-standing sinus bradycardia (SB) in non-elderly patients.

Methods and results

Eleven non-elderly patients (mean age, 45.9 ± 10.9 years; eight men) with a long history of SB (106.2 ± 43.7 months; range, 60–189) were enrolled. Five atrial ganglionated plexies (GPs), identified by anatomic distribution and high-frequency stimulation, were targeted and ablated. The end point was elimination of the vagal response at ablation sites. The symptoms of SB and Holter were followed up at 3 days, 6, and 12 months and, thereafter, over a period of 18 months. Six patients were under 50 years old (group I) and 5 patients were between 50 and 60 years old (group II). There were 3.1 ± 0.7 GPs with positive vagal response and 11.3 ± 2.7 ablation sites in each patient. During the 18.4 ± 6.2 (range, 12–25) months of follow-up, all patients reported significant symptom improvement with a significant decrease of the SB-related symptoms score. The total heartbeats, mean, and minimum heart rate significantly increased that persisted for 12 months. Compared with patients in group II, those in group I had more increases in total heartbeats and mean heart rate (HR).

Conclusion

Atrial autonomic denervation increases sinus rate and improves symptoms in non-elderly patients with symptomatic long-standing SB, thus, potentially serving as an alternative to pacemaker implantation.

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References

  1. Brignole, M., Auricchio, A., Baron-Esquivias, G., Bordachar, P., Boriani, G., Breithardt, O. A., et al. (2013). 2013 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy: the Task Force on cardiac pacing and resynchronization therapy of the European Society of Cardiology (ESC). Developed in collaboration with the European Heart Rhythm Association (EHRA). European Heart Journal, 34, 2281–2329.

    Article  PubMed  Google Scholar 

  2. Epstein, A. E., DiMarco, J. P., Ellenbogen, K. A., Estes, N. A., 3rd, Freedman, R. A., Gettes, L. S., et al. (2008). ACC/AHA/HRS 2008 Guidelines for Device-Based Therapy of Cardiac Rhythm Abnormalities: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the ACC/AHA/NASPE 2002 Guideline Update for Implantation of Cardiac Pacemakers and Antiarrhythmia Devices) developed in collaboration with the American Association for Thoracic Surgery and Society of Thoracic Surgeons. Journal of the American College of Cardiology, 51, e1–e62.

    Article  PubMed  Google Scholar 

  3. Tse, H. F., & Lau, C. P. (2005). Prevalence and clinical implications of atrial fibrillation episodes detected by pacemaker in patients with sick sinus syndrome. Heart, 9, 362–364.

    Article  Google Scholar 

  4. Wang, M., Lau, C. P., Zhang, X. H., SiuCW, L. K. L. F., & Tse, H. F. (2009). Interatrial mechanical dyssynchrony worsened atrial mechanical function in sinus node disease with or without paroxysmal atrial fibrillation. Journal of Cardiovascular Electrophysiology, 20, 1237–1242.

    Article  PubMed  Google Scholar 

  5. Wang, M., Siu, C. W., Lee, K. L., Yue, W. S., Yan, G. H., Lee, S., et al. (2011). Effects of right low atrial septal vs. right atrial appendage pacing on atrial mechanical function and dyssynchrony in patients with sinus node dysfunction and paroxysmal atrial fibrillation. Europace, 13, 1268–1274.

    Article  PubMed  Google Scholar 

  6. Chiou, C. W., Eble, J. N., & Zipes, D. P. (1997). Efferent vagal innervation of the canine atria and sinus and atrioventricular nodes. The third fat pad. Circulation, 95, 2573–2584.

    Article  CAS  PubMed  Google Scholar 

  7. Guyton, A. C., Hall, J. E. (1996). The autonomic nervous system. The Adrenal Medulla, textbook of medical physiology. 9th ed, W.B. Saunders Company. p, 769–781.

  8. Scherlag, B. J., Nakagawa, H., Jackman, W. M., Yamanashi, W. S., PattersonE, P. S., et al. (2005). Electrical stimulation to identify neuralelements on the heart: their role in atrial fibrillation. Journal of Interventional Cardiac Electrophysiology, 13(Suppl 1), 37–42.

    Article  PubMed  Google Scholar 

  9. Liang, Z., Jiayou, Z., Zonggui, W., & Dening, L. (2012). Selective atrial vagal denervation guided by evoked vagal reflex to treat refractory vasovagal syncope. Pacing Clinical Electrophysiology, 35, e214–e218.

    Article  PubMed  Google Scholar 

  10. Jose, A. D., & Collison, D. (1970). The normal range and determinants of the intrinsic heart rate in man. Cardiovascular Research, 4, 160–167.

    Article  CAS  PubMed  Google Scholar 

  11. Johansen, J. B., Jorgensen, O. D., Moller, M., Arnsbo, P., Mortensen, P. T., & Nielsen, J. C. (2011). Infection after pacemaker implantation: infection rates and risk factors associated with infection in a population-based cohort study of 46299 consecutive patients. European Heart Journal, 32, 991–998.

    Article  PubMed Central  PubMed  Google Scholar 

  12. Auricchio, A., Delnoy, P. P., Regoli, F., Seifert, M., Markou, T., Butter, C., et al. (2013). First-in-man implantation of leadless ultrasound-based cardiac stimulation pacing system: novel endocardial left ventricular resynchronization therapy in heart failure patients. Europace, 15, 1191–1197.

    Article  PubMed  Google Scholar 

  13. Hou, Y., Scherlag, B. J., Lin, J., Zhou, J., Song, J., Zhang, Y., et al. (2007). Interactive atrial neural network: determining the connections between ganglionated plexi. Heart Rhythm, 4, 56–63.

    Article  PubMed  Google Scholar 

  14. Ardell, J. L., & Randall, W. C. (1986). Selective innervation of sino-atrial and atrioventricular nodes in canine heart. American Journal of Physiology, 251, H764–H773.

    CAS  PubMed  Google Scholar 

  15. Lazzara, R., Scherlag, B. J., Robinson, M. J., & Samet, P. (1973). Selective in situ parasympathetic control of the canine sinoatrial and atrioventricular nodes. Circulation Research, 32, 393–401.

    Article  CAS  PubMed  Google Scholar 

  16. Quan, K. J., Lee, J. H., Van Hare, G. F., Biblo, L. A., Mackall, J. A., & Carlson, M. D. (2002). Identification and characterization of atrioventricular parasympathetic innervation inhumans. Journal of Cardiovascular Electrophysiology, 13, 735–739.

    Article  PubMed  Google Scholar 

  17. Chiou, C. W., Eble, J. N., & Zipes, D. P. (1997). Efferent vagal innervation of the canine atria and sinus and atrioventricular nodes. Circulation, 95, 2573–2584.

    Article  CAS  PubMed  Google Scholar 

  18. Scanavacca, M., Pisani, C. F., Hachul, D., Lara, S., Hardy, C., Darrieux, F., et al. (2006). Selective atrial vagal denervation guidedby evoked vagal reflex to treat patients with paroxysmal atrialfibrillation. Circulation, 114, 876–885.

    Article  PubMed  Google Scholar 

  19. Yao, Y., Shi, R., Wong, T., Zheng, L., Chen, W., Yang, L., et al. (2012). Endocardial autonomic denervation of the left atria to treat vasovagal syncope: an early experience in humans. Circulation. Arrhythmia and Electrophysiology, 5, 279–286.

    Article  PubMed  Google Scholar 

  20. Katritsis, D. G., Pokushalov, E., Romanov, A., Giazitzoglou, E., Siontis, G. C., Po, S. S., et al. (2013). Autonomic denervation added to pulmonary vein isolation for paroxysmal atrial fibrillation: a randomized clinical trial. Journal of the American College of Cardiology, 62, 2318–2325.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Cardiology, Shanghai Chest Hospital, Shanghai Jiaotong University, 241 West Huaihai Road, Shanghai, 200030, China

    Liang Zhao, Weifeng Jiang, Li Zhou, Yuanlong Wang, Xiaodong Zhang, Shaohui Wu, Kai Xu & Xu Liu

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  1. Liang Zhao
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  2. Weifeng Jiang
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  3. Li Zhou
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  4. Yuanlong Wang
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  5. Xiaodong Zhang
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  6. Shaohui Wu
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  7. Kai Xu
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  8. Xu Liu
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Correspondence to Xu Liu.

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Zhao, L., Jiang, W., Zhou, L. et al. Atrial autonomic denervation for the treatment of long-standing symptomatic sinus bradycardia in non-elderly patients. J Interv Card Electrophysiol 43, 151–159 (2015). https://doi.org/10.1007/s10840-015-9981-8

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  • DOI: https://doi.org/10.1007/s10840-015-9981-8

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