Extra‐cardiac vagal stimulation: Clinical utility of a novel diagnostic and therapeutic tool in supraventricular tachycardia
Abstract Background The differential diagnosis of supraventricular tachycardias (SVTs) is essential during radiofrequency‐(RF) ablation. The extracardiac vagal stimulation (ECVS), introduced in 2015, offers new insights for electrophysiological studies and ablation, allowing controlled cardiac vagal...
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| Format: | Article |
| Language: | English |
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Wiley
2025-08-01
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| Series: | Journal of Arrhythmia |
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| Online Access: | https://doi.org/10.1002/joa3.70134 |
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| author | Jose Carlos Pachon‐M Enrique Pachon‐M Tasso Lobo Tomas Santillana‐P Carlos Pachon Juan Pachon‐M Christian Higuti Maria Zelia Pachon John Clark |
| author_facet | Jose Carlos Pachon‐M Enrique Pachon‐M Tasso Lobo Tomas Santillana‐P Carlos Pachon Juan Pachon‐M Christian Higuti Maria Zelia Pachon John Clark |
| author_sort | Jose Carlos Pachon‐M |
| collection | DOAJ |
| description | Abstract Background The differential diagnosis of supraventricular tachycardias (SVTs) is essential during radiofrequency‐(RF) ablation. The extracardiac vagal stimulation (ECVS), introduced in 2015, offers new insights for electrophysiological studies and ablation, allowing controlled cardiac vagal effect. Methods Prospective study of 625 SVT ablation patients. ECVS was performed using a regular electrophysiology catheter to study atrioventricular (AV) and ventriculo‐atrial (VA) conduction and their effects on tachycardia. Baseline ECVS was performed to determine the optimal position for right or left ECVS, near the jugular foramen. ECVS was repeated during atrial and ventricular pacing (VP) to monitor the procedure's progression and ensure successful endpoints. Results ECVS was successful in 611/625 patients (98%), 381 (62.3%) had AV node reentry tachycardia‐(AVNRT), and 230 (37.6%) accessory pathway (AP), including 135‐(58.7%) anterograde AP (WPW) and 95 (41.3%) concealed AP. ECVS + VP in 33 patients with atypical AVNRT yielded VA block in 32‐(97%), suggesting VA conduction solely via the AV node. In contrast, 57 patients with concealed para‐septal AP maintained VA conduction during ECVS, confirming AP. ECVS proved to be a fast, reliable, and practical additional EP tool: VA block indicated AVNRT, while persistent VA conduction suggested AP. Additionally, ECVS was highly effective in revealing and confirming successful AP ablation by demonstrating the absence of AV and VA anomalous conduction. Conclusion ECVS was a valuable tool in the diagnosis and ablation of SVTs. It allowed reproducible AV and VA block through normal pathways, easily identifying AVNRT and concealed, intermittent, or subtle AP. It was particularly useful in complex cases involving concealed AP and atypical AVNRT tachycardia. |
| format | Article |
| id | doaj-art-a4a2e9adcf98425bb4c7b0529b0ce56a |
| institution | Kabale University |
| issn | 1880-4276 1883-2148 |
| language | English |
| publishDate | 2025-08-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of Arrhythmia |
| spelling | doaj-art-a4a2e9adcf98425bb4c7b0529b0ce56a2025-08-26T10:38:54ZengWileyJournal of Arrhythmia1880-42761883-21482025-08-01414n/an/a10.1002/joa3.70134Extra‐cardiac vagal stimulation: Clinical utility of a novel diagnostic and therapeutic tool in supraventricular tachycardiaJose Carlos Pachon‐M0Enrique Pachon‐M1Tasso Lobo2Tomas Santillana‐P3Carlos Pachon4Juan Pachon‐M5Christian Higuti6Maria Zelia Pachon7John Clark8São Paulo University São Paulo BrazilSão Paulo University São Paulo BrazilSão Paulo Heart Hospital São Paulo BrazilSão Paulo Heart Hospital São Paulo BrazilSão Paulo Heart Hospital São Paulo BrazilSão Paulo University São Paulo BrazilSão Paulo Heart Hospital São Paulo BrazilSão Paulo Heart Hospital São Paulo BrazilAkron Children's Hospital Akron Ohio USAAbstract Background The differential diagnosis of supraventricular tachycardias (SVTs) is essential during radiofrequency‐(RF) ablation. The extracardiac vagal stimulation (ECVS), introduced in 2015, offers new insights for electrophysiological studies and ablation, allowing controlled cardiac vagal effect. Methods Prospective study of 625 SVT ablation patients. ECVS was performed using a regular electrophysiology catheter to study atrioventricular (AV) and ventriculo‐atrial (VA) conduction and their effects on tachycardia. Baseline ECVS was performed to determine the optimal position for right or left ECVS, near the jugular foramen. ECVS was repeated during atrial and ventricular pacing (VP) to monitor the procedure's progression and ensure successful endpoints. Results ECVS was successful in 611/625 patients (98%), 381 (62.3%) had AV node reentry tachycardia‐(AVNRT), and 230 (37.6%) accessory pathway (AP), including 135‐(58.7%) anterograde AP (WPW) and 95 (41.3%) concealed AP. ECVS + VP in 33 patients with atypical AVNRT yielded VA block in 32‐(97%), suggesting VA conduction solely via the AV node. In contrast, 57 patients with concealed para‐septal AP maintained VA conduction during ECVS, confirming AP. ECVS proved to be a fast, reliable, and practical additional EP tool: VA block indicated AVNRT, while persistent VA conduction suggested AP. Additionally, ECVS was highly effective in revealing and confirming successful AP ablation by demonstrating the absence of AV and VA anomalous conduction. Conclusion ECVS was a valuable tool in the diagnosis and ablation of SVTs. It allowed reproducible AV and VA block through normal pathways, easily identifying AVNRT and concealed, intermittent, or subtle AP. It was particularly useful in complex cases involving concealed AP and atypical AVNRT tachycardia.https://doi.org/10.1002/joa3.70134ablationaccessory pathwayCardioneuroablationsupraventricular tachycardiaWolff‐Parkinson‐White |
| spellingShingle | Jose Carlos Pachon‐M Enrique Pachon‐M Tasso Lobo Tomas Santillana‐P Carlos Pachon Juan Pachon‐M Christian Higuti Maria Zelia Pachon John Clark Extra‐cardiac vagal stimulation: Clinical utility of a novel diagnostic and therapeutic tool in supraventricular tachycardia Journal of Arrhythmia ablation accessory pathway Cardioneuroablation supraventricular tachycardia Wolff‐Parkinson‐White |
| title | Extra‐cardiac vagal stimulation: Clinical utility of a novel diagnostic and therapeutic tool in supraventricular tachycardia |
| title_full | Extra‐cardiac vagal stimulation: Clinical utility of a novel diagnostic and therapeutic tool in supraventricular tachycardia |
| title_fullStr | Extra‐cardiac vagal stimulation: Clinical utility of a novel diagnostic and therapeutic tool in supraventricular tachycardia |
| title_full_unstemmed | Extra‐cardiac vagal stimulation: Clinical utility of a novel diagnostic and therapeutic tool in supraventricular tachycardia |
| title_short | Extra‐cardiac vagal stimulation: Clinical utility of a novel diagnostic and therapeutic tool in supraventricular tachycardia |
| title_sort | extra cardiac vagal stimulation clinical utility of a novel diagnostic and therapeutic tool in supraventricular tachycardia |
| topic | ablation accessory pathway Cardioneuroablation supraventricular tachycardia Wolff‐Parkinson‐White |
| url | https://doi.org/10.1002/joa3.70134 |
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