Anatomically guided atrial ganglionated plexus ablation evaluated by extracardiac vagal stimulation for vagally mediated atrioventricular block

摘要

A: Baseline 12-lead electrocardiogram (ECG) showing sinus rhythm, prolonged PR interval (360 ms), and intraventricular conduction delay with right bundle branch block morphology and QRS duration of 155 ms. B: The 24-hour Holter recordings displaying episodes of nocturnal advanced atrioventricular block (3:1) associated with sinus rate slowing, resulting in ventricular pauses longer than 3 seconds. C, D: Electrophysiologic recordings before and after ganglionated plexus (GP) ablation. After GP ablation, there was a marked decrease in sinus cycle length (P-P interval, 1281 vs 810 ms), PR interval (290 vs 180 ms), and AH (atrial-His) interval (177 vs 108 ms). From top to bottom, ECG leads and electrograms from His bundle (His p; His d) are shown.