{
  "abstract": "Background Cardioneuroablation (CNA) is a promising treatment for young patients with cardioinhibitory syncope. However, further research is required to understand both the effectiveness of CNA as a therapeutic treatment option and the optimal procedure approach. We present our initial experience of CNA guided by real-time spectral analysis.Methods Five consecutive patients undergoing CNA ablation were included in this initial experience report. The cohort had a mean age of 39.4 ± 12.5 years, with 60% male patients. Mean BMI was 26.9kg/m2. All patients had structurally normal hearts with preserved left ventricular ejection fraction. Assessments for CNA were in keeping with EHRA guidance. High-density mapping was performed using added data from real-time peak frequency analysis via a proprietary near-field (NF) algorithm. Radiofrequency ablation was delivered at sites of identified ganglionated plexi bi-atrially.Results All patients demonstrated a cardioinhibitory response on clinical assessment before CNA. All procedures were performed under the controlled settings of general anaesthesia. Procedure data included a mean fluoroscopy dose of 44.0 ± 10.3 mGY and total procedure duration of 128.4 ± 46.3 minutes. Bi-atrial ablation of ganglionated plexi was performed in all patients until immediate target heart rate (HR) responses were achieved. Repeat conduction indices were measured, and an atropine test was performed before procedure conclusion. Amongst the conduction indices measured, mean sinus node recovery time (SNRT) improved from 1028ms to 738ms, and in all patients atropine administration caused <10% HR increase. No major procedural complications were observed. The longest follow up to date is 10 months, with no ILR recordings of any pauses (compared to a pre-ablation burden of 1-2 episodes per month) and the patient remains well and asymptomatic. One patient has symptomatic recurrences awaiting further ablation treatment.Conclusion In this initial experience, CNA was feasible with this approach with no acute complications. All patients have continuous monitoring via ILR and so far, have demonstrated a good clinical response following a single ablation procedure, with follow up out to 10 months. Follow up data via a shared registry is required to evaluate long-term efficacy and safety of this contemporary approach to CNA.Abstract 444 Figure 1Bi-atrial electroanatomic map of a case using high density mapping with overlay from peak frequency analysis using the proprietary NF algorithmAbstract 444 Table 1Clinical characteristics of study patientsPatient #Age, yearsSexBMI (kg/m2)ILRSinus arrestAVN blockProcedure duration, min122Male24.75YesNoYes98237Male28.60YesYesYes121350Female30.14YesYesYes75435Male26.73YesYesNo157553Female24.15YesYesNo191ILR: implantable loop recorder; AVN block: atrioventricular nodal blockAbstract 444 Table 2Electrophysiology parameters pre- and post CNA Pre CNAPost CNA∆ (Absolute)%changeHeart rate, bpm68.588+19.5+28.5AH interval, ms79103+24.0+30.4HV interval, ms44.349+4.7+10.6AV Wenckebach, ms387.5375-12.5-3.2Sinus node recovery time, ms1028.4737.8-290.6-28.3CNA: cardioneuroablation; Values displayed as mean.",
  "authors": [
    {
      "affiliations": [
        "St George’s University Hospital, London, United Kingdom"
      ],
      "name": "Viral A Sagar"
    },
    {
      "affiliations": [
        "St George’s University Hospital, London, United Kingdom"
      ],
      "name": "Jaspal S Gill"
    },
    {
      "affiliations": [
        "St George’s University Hospital, London, United Kingdom"
      ],
      "name": "Manav Sohal"
    },
    {
      "affiliations": [
        "St George’s University Hospital, London, United Kingdom",
        "City St George’s",
        "University of London, London, United Kingdom"
      ],
      "name": "Mark M Gallagher"
    },
    {
      "affiliations": [
        "St George’s University Hospital, London, United Kingdom"
      ],
      "name": "Abhay Bajpai"
    },
    {
      "affiliations": [
        "St George’s University Hospital, London, United Kingdom"
      ],
      "name": "Lisa WM Leung"
    }
  ],
  "title": "444 Initial experience of cardioneuroablation for recurrent cardioinhibitory syncope guided by a proprietary near field algorithm for real-time spectral analysis",
  "uid": "60ba4863-4c92-5043-a922-3ae3c1c1964b"
}