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