Great experience in my trip to Argentine.The audience was excited. We performed a live CNA case During my visit. Lots of questions arose during the case and my lectures. Here are some misunderstood tips in #Cardioneuroablation🚨Tweetorial alert. @drraviele @CarlChiefCard
1/10 Atropine blocks the effect of the vagus, by blocking muscarinic receptors, we can use it to predict the outcome of #Cardioneuroablation doi.org/10.1016/j.hrth…. @natale_md @mdTolgaAksu @Josefkautzner @piotrowskiroman @pachon_phd @scanav1mauricio @alfieep
2/10 AT is a great tool for the selection of patients, but its effect compromises the study through extra cardiac vagal stimulation #ECVS. We always use it prior to #CNA for patien selection.
Therefore, is recommended a period longer than 48 hours between its administration and the ablation procedure. 🚨Atropine should be avoided before and during the #cardioneuroablation. Reserved only for the end, confirming the absence of increase in Sinus rate
3/10 2nd step in #CNA: Mapping both atria, identifying and annotating fractionated potentials. Using fractionation mapping or manual annotation. Adapting for available tools. Defining the surfaces crowding of characteristic potentials that will serve as a guide for ablation 
4/10 #ECVS should be always performed under general anesthesia, through a catheter via endovascular access from the femoral vein to the right or left internal jugular vein. Using a neurostimulator capable of being prog. with these Set pmtrs: 1 Volt/kg max70V PW:0.05 mseg / 50 Hz
5/10 To keep it simple, we suggest 4 areas for mapping and ablation in CNA related to the 4 major ganglionic plexuses
6/10 You may often see vagal responses during ablation: bradycardia and AVB in left PVs and increased sinus rate in right PVs or over areas related to septal GPs
7/10 After ablation of each area, confirmation of the denervation level reached is performed. Less is more! Zero #EVCS response means a higher vagal denervation level, you know when you are done
8/10 End points: 1️⃣sustained HR & Wenckebach increase: basal<final. 2️⃣Normal PR. 3️⃣Final result with ECVS is abolishment of vagal response that means no changes in sinus rate or PR.
9/10 4️⃣Atropine challenge is always reserved for the end of the procedure, after Intravenous infusion no changes in sinus rate is expected. Sufficient #CNA means no HR increase at all . jca.org.br/jca/article/vi…
10/10 to go further with this brainstorming tweetorial: Zero response to #EVCS after successful #CNA = Zero to Atropine test.
A negative #EVCS means always a negative atropine test, so #AT use using EVCS is not mandatory and gives you the chance to ablate less or more
A negative #EVCS means always a negative atropine test, so #AT use using EVCS is not mandatory and gives you the chance to ablate less or more
… depending on the case. It is all dynamic and workflow depends in every case, making a more physiological-end point based. If you do not believe me, just try #ECVS in #CNA
If you have come this far.
Take a look at our latest work. doi.org/10.1016/j.hrcr…
Take a look at our latest work. doi.org/10.1016/j.hrcr…
2/10 AT is a great tool for the selection of patients, but its effect compromises the study through extra cardiac vagal stimulation #ECVS. We always use it prior to #CNA for patien selection.@ALFIEEP1 #EPeeps
Therefore, is recommended a period longer than 48 hours between its administration and the ablation procedure. 🚨Atropine should be avoided before and during the #cardioneuroablation. Reserved only for the end, confirming the absence of increase in Sinus rate
3/10 2nd step in #CNA: Mapping both atria, identifying and annotating fractionated potentials. Using fractionation mapping or manual annotation. Adapting for available tools. Defining the surfaces crowding of characteristic potentials that will serve as a guide for ablation.
4/10 #ECVS should be always performed under general anesthesia, through a catheter via endovascular access from the femoral vein to the right or left internal jugular vein. Using a neurostimulator capable of being prog. with these Set pmtrs: 1 Volt/kg max70V PW:0.05 mseg / 50 Hz
5/10 To keep it simple, we suggest 4 areas for mapping and ablation in CNA related to the 4 major ganglionic plexuses
6/10 You may often see vagal responses during ablation: bradycardia and AVB in left PVs and increased sinus rate in right PVs or over areas related to septal GPs
7/10 After ablation of each area, confirmation of the denervation level reached is performed. Less is more! Zero #EVCS response means a higher vagal denervation level, you know when you are done
8/10 End points: 1️⃣sustained HR & Wenckebach increase: basal<final. 2️⃣Normal PR. 3️⃣Final result with ECVS is abolishment of vagal response that means no changes in sinus rate or PR.
9/10 4️⃣Atropine challenge is always reserved for the end of the procedure, after Intravenous infusion no changes in sinus rate is expected. Sufficient #CNA means no HR increase at all . jca.org.br/jca/article/vi…
10/10 to go further with this brainstorming tweetorial: Zero response to #EVCS after successful #CNA = Zero to Atropine test.
A negative #EVCS means always a negative atropine test, so #AT use using EVCS is not mandatory and gives you the chance to ablate less or more
A negative #EVCS means always a negative atropine test, so #AT use using EVCS is not mandatory and gives you the chance to ablate less or more
If you have come this far.
Take a look at our latest work. doi.org/10.1016/j.hrcr…
Take a look at our latest work. doi.org/10.1016/j.hrcr…
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