Tolga Aksu1, Tom De Potter2, Leah John3, Jose Osorio4, David Singh5, Daniel Alyesh6, Erkan Baysal7, Kapil Kumar8, Javad Mikaeili9, Alexander Dal Forno10, Kivanc Yalin11, Baris Akdemir12, Christopher E Woods13, Jonathan Salcedo13, Mahmoud Eftekharzadeh9, Taylan Akgun14, Sri Sundaram6, Dursun Aras15, Wendy S Tzou16, Rakesh Gopinathannair17, Jeffrey Winterfield3, Dhiraj Gupta18, Andre Davila8,10. 1. Department of Cardiology, Yeditepe University Hospital, Istanbul, Turkey. 2. Department of Cardiology, OLV Hospital, Aalst, Belgium. 3. Department of Cardiology, Medical University of South Carolina, South Carolina, USA. 4. Department of Electrophysiology, Arrhythmia Institute at Grandview, Alabama, USA. 5. Division of Cardiology, The Queen's Medical Center, Honolulu, Hawaii, USA. 6. Department of Electrophysiology, Cardiac Electrophysiology, South Denver Cardiology Associates, Littleton, Colorado, USA. 7. Department of Cardiology, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Turkey. 8. Department of Cardiology, Beth Israel Deaconess Medical Center, Boston, USA. 9. Department of Electrophysiology, Day General Hospital, Tehran, Iran. 10. SOS Cardio Hospital, Florinapolis, Brazil. 11. Department of Cardiology, Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey. 12. Department of Cardiology, Goztepe Medicalpark Hospital, Bahcesehir University, Istanbul, Turkey. 13. Department of Cardiology, Palo Alto Medical Foundation, Mills-Peninsula Medical Center, Burlingame, California, USA. 14. Basaksehir Cam and Sakura City Hospital, Başakşehir, Turkey. 15. Ankara City Hospital, Ankara, Turkey. 16. Division of Cardiovascular Medicine, Cardiac Electrophysiology Section, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA. 17. Department of Cardiology, Kansas City Heart Rhythm Institute and Research Foundation, Kansas City, Missouri, USA. 18. Department of Electrophysiology, Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, Liverpool, UK.
Abstract
INTRODUCTION: Single-center observational studies have shown promising results with fragmented electrogram (FE)-guided ganglionated plexus (GP) ablation in patients with vagally mediated bradyarrhythmia (VMB). We aimed to compare the acute procedural characteristics during FE-guided GP ablation in patients with VMB performed by first-time operators and those of a single high-volume operator. METHODS AND RESULTS: This international multicenter cohort study included data collected over 2 years from 16 cardiac hospitals. The primary operators were classified according to their prior GP ablation experience: a single high-volume operator who had performed > 50 GP ablation procedures (Group 1), and operators performing their first GP ablation cases (Group 2). Acute procedural characteristics and syncope recurrence were compared between groups. Forty-seven consecutive patients with VMB who underwent FE-guided GP ablation were enrolled, n = 31 in Group 1 and n = 16 in Group 2. The mean number of ablation points in each GP was comparable between groups. The ratio of positive vagal response during ablation on the left superior GP was higher in Group 1 (90.3% vs. 62.5%, p = .022). Ablation of the right superior GP increased heart rate acutely without any vagal response in 45 (95.7%) cases. The procedure time was longer in group 2 (83.4 ± 21 vs. 118.0 ± 21 min, respectively, p < .001). Over a mean follow-up duration of 8.0 ± 3 months (range 2-24 months), none of the patients suffered from syncope. CONCLUSION: This multi-center pilot study shows for the first time the feasibility of FE-guided GP ablation across a large group of procedure-naïve operators.
INTRODUCTION: Single-center observational studies have shown promising results with fragmented electrogram (FE)-guided ganglionated plexus (GP) ablation in patients with vagally mediated bradyarrhythmia (VMB). We aimed to compare the acute procedural characteristics during FE-guided GP ablation in patients with VMB performed by first-time operators and those of a single high-volume operator. METHODS AND RESULTS: This international multicenter cohort study included data collected over 2 years from 16 cardiac hospitals. The primary operators were classified according to their prior GP ablation experience: a single high-volume operator who had performed > 50 GP ablation procedures (Group 1), and operators performing their first GP ablation cases (Group 2). Acute procedural characteristics and syncope recurrence were compared between groups. Forty-seven consecutive patients with VMB who underwent FE-guided GP ablation were enrolled, n = 31 in Group 1 and n = 16 in Group 2. The mean number of ablation points in each GP was comparable between groups. The ratio of positive vagal response during ablation on the left superior GP was higher in Group 1 (90.3% vs. 62.5%, p = .022). Ablation of the right superior GP increased heart rate acutely without any vagal response in 45 (95.7%) cases. The procedure time was longer in group 2 (83.4 ± 21 vs. 118.0 ± 21 min, respectively, p < .001). Over a mean follow-up duration of 8.0 ± 3 months (range 2-24 months), none of the patients suffered from syncope. CONCLUSION: This multi-center pilot study shows for the first time the feasibility of FE-guided GP ablation across a large group of procedure-naïve operators.