Cardioneuroablation
All cases underwent orotracheal intubation, general intravenous
anesthesia controlled by BIS (Brain Index Spectral®) and transesophageal
echocardiogram. Parasympatholytic drugs were proscribed for the last two
days. A conventional recorder and NAVX-Ensite® Velocity/Precision St
Jude/Abbott electroanatomic mapping system were installed. The catheters
were deployed under pulsed radioscopy by femoral vein using the
Seldinger technique. A duodecapolar catheter was positioned in the
coronary sinus. Left atrium was accessed by transseptal puncture. A
decapolar circular catheter was used to get the 3D anatomical model,
simultaneously achieving fractionation map. Ablation were proceeded by
an irrigated RF St Jude/Abbott Flexability catheter by the classical
technique for AF ablation with pulmonary vein
isolation16 and for
CNA3,4 . Coagulation activated time
between 300 to 400s was maintained by adjusting intravenous heparin
infusion. Ablations were performed in the following anatomical
landmarks: at the P zone (left interatrial septum between foramen oval,
right pulmonary veins and left atrial roof), at the roof of the coronary
sinus, at the Waterston groove and at the regions of the four main
PGs3,17,18. In the
latter, prolonged ablations of 1 to 2 minutes were performed to obtain
deep epicardial effect, Figure 3.
Figure 3