PO-03-072 CARDIONEUROABLATION AS AN ALTERNATIVE TREATMENT FOR PATIENTS WITH CAROTID SINUS SYNDROME - A MULTICENTER EXPERIENCE

Abstract

Carotid sinus syndrome (CSS) is an uncommon condition caused by sudden vagal overactivity resulting in sinus arrest, AV block (AVB) and syncope commonly treated with pacemaker (PM). Cardioneuroablation (CNA) aims vagal denervation removing cardio inhibition by endocardial ablation Study outcomes of CNA controlled by extracardiac vagal stimulation (ECVS) and carotid sinus massage (CSM) in CSS. Prospective, controlled, clinical study including 11 patients with a clinical history of repetitive syncope caused by CSS, in 3 hospital centers in Brazil and 1 in Spain. Presenting positive carotid sinus massage, with pauses > 3 seconds, and positive response to atropine test, ruling out hypotensive component as cause of syncope. Bi-atrial CNA identifying AF-Nests (AFN), ablating the P point and the 4 main areas related to ganglionic plexuses (GP). Vagal denervation control by ECVS was used to define extension of the denervation, and in addition CSM was performed to confirm immediate success at the end of the ablation, defining the higher CNA effect. Primary endpoint: eliminate pauses and AVB caused by ECVS and CSM. Secondary end points: Time to syncope event after CNA, time to diagnose of cardio inhibition induced by CSM after CNA Mean age 55,9(±16,3), mean syncope episodes 7,7 (±6,9). Pre-CNA ECVS and CSM response: sinus pauses (5,7 ±1,4secs), transient AVB 4/11. Post-CNA, ECVS, CSM and Atropine responses were completely abolished in 100%. Obtained HR increase (59.1±11,1/80,3±5,1bpm). Follow-up 25,7(±17,1) months, no syncope recurrence. ECVS was successfully performed in 10/11, in 1 patient it was not possible to advance the catheter through any jugular vein, ECVS was not performed; 1 patient had positive CSM at 6 months FU, had PM implanted, without any spontaneous syncope events. No complications or proarrhythmic effect were registered. Bi atrial CNA AFN/GP based ablation guided by abolishment ECVS and CSM response was effective, feasible, and reproducible for eliminating syncope recurrence in all patients with CSS. Control of vagal denervation using ECVS defined the extent of denervation and confirmed immediate success. CNA may be considered as an option for CSS treatment.