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Cardioneuroablation
A frequent type of sycnope, termed vasovagal syncope is originated by intense cardioinhibition, mediated by a sudden vagal reflex, that causes transitory cardiac arrest by asystole and/or transient total atrioventricular block.〔Brignole, M, Alboni, P, Benditt, DG, et al. Guidelines on management (diagnosis and treatment) of syncope--update 2004. Europace 2004; 6:467.〕〔Morillo CA; Eckberg DL; Ellenbogen KA; Beightol LA; Hoag JB; Tahvanainen KU; Kuusela TA; Diedrich - Vagal and sympathetic mechanisms in patients with orthostatic vasovagal syncope. Circulation 1997 Oct 21;96(8):2509-13.〕 It is known as “Vaso-vagal Syncope”, “Neurocardiogenic Syncope” or “Neurally-mediated Reflex Syncope”.〔Olshansky B - Pathogenesis and etiology of syncope - 2013 UpToDate – www.uptodate.com〕 Although many different therapies have been tried in this condition, severe and refractory cases have been treated with pacemaker implantation despite great controversies about its benefit.〔Raviele A, Giada F, Menozzi C, et al. Vasovagal Syncope and Pacing Trial Investigators. A randomized, double-blind, placebo-controlled study of permanent cardiac pacing for the treatment of recurrent tilt-induced vasovagal syncope. The vasovagal syncope and pacing trial (SYNPACE). 1. Eur Heart J. 2004 Oct;25(19):1741-8.〕〔Connolly SJ, Morillo C, et al. VPS II Study. JAMA. 2003 May 7;289(17):2224-9.〕
The “Cardioneuroablation” is a technique created in the nineties and patented in USA, aiming to eliminate the cardiac branch of vagal reflex in order to treat the neurocardiogenic syncope without pacemaker implantation.〔Pachon JC, Pachon EI, Pachon JC, Lobo TJ, Pachon MZ, Vargas RN, Jatene AD. "Cardioneuroablation"--new treatment for neurocardiogenic syncope, functional AV block and sinus dysfunction using catheter RF-ablation. Europace. 2005 Jan;7(1):1-13. PubMed PMID 15670960.〕〔Pachon M JC, Pachon M EI, Lobo TJ, Pachon M JC, Pachon MZ, Vargas RN, Manrique RM, Jatene AD. Syncopal high-degree AV block treated with catheter RF ablation without pacemaker implantation. Pacing Clin Electrophysiol. 2006 Mar;29(3):318-22.〕 It is performed without surgery, by using radiofrequency catheter ablation with one-day hospital.
The results up to 100 months follow-up are showing better outcome than clinical measures or pacemaker implantation with changing the tilt-test on to normal and by absence of syncope in more than 90% of patients without medications.〔Pachon JC, Pachon EI, Cunha Pachon MZ, Lobo TJ, Pachon JC, Santillana TG. Catheter ablation of severe neurally meditated reflex (neurocardiogenic or vasovagal) syncope: cardioneuroablation long-term results. Europace. 2011 Sep;13(9):1231-42. doi: 10.1093/europace/eur163. Epub 2011 Jun 28. PubMed PMID 21712276.〕〔Barón-Esquivias G, Errázquin F, Pedrote A, Cayuela A, Gómez S, Aguilera A, Campos A, Fernández M, Valle JI, Redondo M, Fernández JM, Martínez A, Burgos J, Martínez-Rubio A. - Long-term outcome of patients with vasovagal syncope. Am Heart J. 2004 May;147(5):883-9.〕
==References==
*(United States Patent 8,216,228 - Pachon Mateos, et al. )
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