Cardioneuroablation for successful treatment of symptomatic bradycardia in a 12-year-old child after a 6-month follow-up

Xin Xu; Shuang He; Qian Liu; Ruixi Liu; Lei Zhang; Weijie Chen; Yuehui Yin; Tiewei Lu

doi:10.3389/fcvm.2023.1290482

Cardioneuroablation for successful treatment of symptomatic bradycardia in a 12-year-old child after a 6-month follow-up

Front Cardiovasc Med. 2023 Nov 29:10:1290482. doi: 10.3389/fcvm.2023.1290482. eCollection 2023.

Authors

Xin Xu¹, Shuang He¹, Qian Liu¹, Ruixi Liu¹, Lei Zhang¹, Weijie Chen², Yuehui Yin², Tiewei Lu¹

Affiliations

¹ Department of Cardiology, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics, Chongqing, China.
² Department of Cardiology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China.

Abstract

Background: Cardioneuroablation (CNA) is recognized as a promising therapeutic option for adults with severe symptomatic bradycardia caused by excessive vagal tone. However, no pediatric cases have been reported to date. Therefore, the aim of this study is to evaluate the feasibility and efficacy of CNA in children.

Methods: A 12-year-old male patient was hospitalized with symptoms of fatigue, palpitations, and syncope for more than 2 months, and was definitively diagnosed with functional sinoatrial node dysfunction by using a 12-lead electrocardiogram, 24-h Holter monitoring, loading dose of atropine test (0.04 mg/kg), and treadmill exercise test. Simultaneously, whole-exome sequencing was performed on the child and his core family members. After completing the preoperative examination and signing the informed consent form, the child underwent CNA therapy.

Results: First, the electroanatomic structures of both atria were mapped out by using the Carto 3 system, according to the protocol of purely anatomy-guided and local fractionated intracardiac electrogram-guided CNA methods. Then, the local fractionated intracardiac electrograms of each cardiac ganglionated plexus (GP), including the GP between the aortic root and the medial wall of the superior vena cava, the GP between the posterior wall of the coronary sinus ostium and the left atrium, the GP between the anterior antrum of the right superior pulmonary vein and the superior vena cava, the GP in the superolateral area around the root of the left superior pulmonary vein, the GP around the root of the right inferior pulmonary vein, and the GP around the root of the left inferior pulmonary vein, were used as targets for ablation at a power of 30 W with an ablation index of 350-400. At a 6-month follow-up, the child's heart rhythm saw a complete restoration to sinus rhythm and clinical symptoms disappeared.

Conclusion: The first application of CNA in a child with symptomatic sinus bradycardia was achieved with better clinical outcomes. CNA can be carried out cautiously in children under suitable indications.

Keywords: cardioneuroablation (CNA); children; ganglionated plexus; sinus arrest; sinus bradycardia; vagal tone.

Grants and funding

The authors declare that financial support was received for the research, authorship, and/or publication of this article.