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• W2895841366 abstract "We read with great interest the case report of cardioneuroablation in ictal asystole by Antolic and colleagues.1Antolic B. Rutar Gorisek V. Granda G. Lorber B. Sinkovec M. Zizek D. Cardioneuroablation in ictal asystole—new treatment method.HeartRhythm Case Rep. 2018; 4: 523-526Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar They tried to ablate ganglionated plexi (GPs) by targeting fractionated electrograms (EGMs) in the anatomic areas where GPs for sinus and atrioventricular node innervation are located. The usage of fractionated EGMs for cardioneuroablation was first defined by our group.2Aksu T. Guler T.E. Yalin K. Bozyel S. Vagal ganglia ablation: a little-known route in the treatment of vasovagal syncope.EP Lab Digest. 2017; 17: 26-27Google Scholar, 3Aksu T. Guler T.E. Mutluer F.O. Bozyel S. Golcuk S.E. Yalin K. Electroanatomic-mapping-guided cardioneuroablation versus combined approach for vasovagal syncope: a cross-sectional observational study.https://doi.org/10.1007/s10840-018-0421-4Google Scholar In our protocol, bipolar endocardial atrial EGMs were evaluated for amplitude and number of deflections at special filter settings and sweep speed. All EGMs were divided into the following subgroups: normal, low-amplitude fractionated EGM (LAFE), and high-amplitude fractionated EGM (HAFE). Then, the sites demonstrating HAFE or LAFE pattern in a region that is consistent with probable localization of GPs were tagged as ablation targets in both atria. Other sites demonstrating LAFE pattern were accepted as scar tissue and excluded from the assessment. In the present work, the authors should have defined why all sites demonstrating fractionated pattern were not targeted, because it is well known that superior and inferior left atrial GPs are located between the left pulmonary veins (PVs) and the left atrial appendage and within the fat pad below the left inferior PV, respectively.4Stavrakis S. Po S. Ganglionated plexi ablation: physiology and clinical applications.Arrhythm Electrophysiol Rev. 2017; 6: 186-190Crossref PubMed Scopus (42) Google Scholar In our research, we demonstrated that both superior and inferior left atrial GPs might be detected by using fractionated EGMs.3Aksu T. Guler T.E. Mutluer F.O. Bozyel S. Golcuk S.E. Yalin K. Electroanatomic-mapping-guided cardioneuroablation versus combined approach for vasovagal syncope: a cross-sectional observational study.https://doi.org/10.1007/s10840-018-0421-4Google Scholar Although the majority of the fractionated EGMs were detected at the insertion of the right PVs and at the superior vena cava insertions or surrounding the coronary sinus ostium in the left and right atria, respectively, the number of fractional EGMs was higher than that found in the interatrial septum.3Aksu T. Guler T.E. Mutluer F.O. Bozyel S. Golcuk S.E. Yalin K. Electroanatomic-mapping-guided cardioneuroablation versus combined approach for vasovagal syncope: a cross-sectional observational study.https://doi.org/10.1007/s10840-018-0421-4Google Scholar The main problem for the cardioneuroablation procedure is to localize GPs. Our new electroanatomic mapping–guided strategy may be used to define GP sites by using conventional electrophysiological equipment to achieve complete vagal denervation. Cardioneuroablation in ictal asystole—New treatment methodHeartRhythm Case ReportsVol. 4Issue 11PreviewWe describe a case of successful parasympathetic denervation of the sinus node using cardioneuroablation in a patient with right temporal lobe epilepsy and prolonged ictal asystole. The procedure abolished seizure-induced bradyarrhythmia occurrence and converted the patient’s dramatic seizures with severe cerebral hypoperfusion into short focal seizures with minimal motor signs. To the best of our knowledge, this is the first report of a successful cardioneuroablation procedure to potentially treat ictal asystole. Full-Text PDF Open AccessReply to the Editor— The proper usage of electroanatomic mapping–guided cardioneuroablationHeartRhythm Case ReportsVol. 4Issue 12PreviewWe appreciate Aksu and colleagues for showing interest in our case in which we present cardioneuroablation as a treatment option to prevent ictal asystole.1 Full-Text PDF Open Access" @default.
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• W2895841366 date "2018-12-01" @default.
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• W2895841366 title "To the Editor— The proper usage of electroanatomic mapping–guided cardioneuroablation" @default.
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