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32. Cardiovascular Nursing
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Atrial ganglionated plexi modification combined with pulmonary vein isolation for the treatment of paroxysmal atrial fibrillation and baseline bradycardia
Session:
Sessão de Comunicações Orais 13 – Para além do isolamento das veias pulmonares: estratégias avançadas na ablação da fibrilhação auricular
Speaker:
Mário Martins Oliveira
Congress:
CPC 2026
Topic:
C. Arrhythmias and Device Therapy
Theme:
05. Atrial Fibrillation
Subtheme:
05.4 Atrial Fibrillation - Treatment
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Mário Martins Oliveira; Pedro Silva Cunha; Sergio Laranjo; Bruno Valente; Guilherme Portugal; Ana Lousinha; Helder Santos; Tiago Constantino; Ana Sofia Trindade; Margarida Paulo; Ana Sofia Delgado; Rui Cruz Ferreira
Abstract
<p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:11.0pt">Experimental and clinical studies have established a dominant role of autonomic nervous system activity in the initiation and maintenance of atrial fibrillation (AF). Increased vagal tone is strongly associated with bradycardia and increased risk of developing AF. In patients (P) with AF and significant bradicardia, combining pulmonary vein isolation (PVI) with atrial ganglionated plexi (GP) modification may emerge as an ablative strategy.</span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt"><span style="color:black">Aim:</span></span></strong> <span style="font-size:11.0pt">evaluate the safety and success rates of combining PVI and anatomical-based modification of the major left atrial GP in P with paroxysmal AF (PAF) and baseline sinus bradycardia (<u><</u>50 bpm), submitted to a first AF ablation. </span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt">Methods:</span></strong><span style="font-size:11.0pt"> 34P (51±14 years; 27 male; 85% engaged with regular exercise, left atrial volume 32-56 ml/m2; left ventricular ejection fraction >50%; CHADSVASc 0-2; AAD used as “pill in the pocket”) undergoing PVI + left atrial empiric GP sites ablation with radiofrequency (RF).<span style="color:black"> All P performed a cardiac CT before ablation to <span style="background-color:white">provide detailed 3-D images and exclude intracardiac thrombus.</span> Electroanatomic mapping for anatomic geometry reconstruction was performed with NAVx Ensite (Abbot Inc.) or Carto system (Biosense Webster Inc). </span>The primary outcome was the freedom from AF or sustained atrial tachycardia during 18-month follow-up verified by ECG (every 6 months or if symptoms), external event recorder (blanking period), and a 24h-Holter (between 6 and 12 months). </span></span></span></p> <p style="text-align:justify"><span style="font-size:12pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:11.0pt">Results:</span></strong><span style="font-size:11.0pt"> P underwent successful PVI (4-5 PV) and RF modification of the four GP in the vicinity of the PV. The average procedure time was 124 min and fluoroscopy time 12 min. The duration of RF (30-35W) was 40±10min. At the end of the procedure, there was a stable acute increase of heart rate between 11bpm and 24bpm. A pericardial effusion was drained in the laboratory, with no other acute complications. The mean heart rate (24h-Holter recording) changed from 52 bpm to 66 bpm, before and 6-12 months after ablation, respectively (p<0,05). At 18-month follow-up, maintenance of sinus rhythm was 77%%, with an EHRA score for AF-related symptoms of I-II. <strong>Conclusion</strong>: Anatomical-based left atrial neuromodulation as an adjunctive procedure to PVI may provide benefits in AF suppression for the treatment of P suffering from AF and sinus bradycardia.</span></span></span></p>
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