Catheter Ablation for Frequent Premature Ventricular Contractions or Paroxysmal Supraventricular Tachycardia With Vagal Bradycardia: A New Clinical Application of Superior Vena Cava–Aorta Ganglionated Plexus Modification

BACKGROUND: Frequent premature ventricular contractions (PVCs) or paroxysmal supraventricular tachycardia (PSVT) in patients with bradyarrhythmia is difficult to treat. Cardioneuroablation (CNA) is now considered a promising treatment for vagally mediated bradyarrhythmia. HYPOTHESIS: Modifying the right atrial superior vena cava-aorta ganglionated plexus (Ao-SVC GP) improves heart rate and prognosis in vagal bradycardia with tachyarrhythmias. METHODS: We enrolled 110 patients with PVCs or PSVT and vagal bradycardia who underwent catheter ablation. Patients were randomized into the CNA group (n = 55) and the control group (n = 55). All patients underwent a conventional electrophysiological examination and ablation of PVCs or PSVT. Next, we performed Ao-SVC GP modification in patients in the CNA group. The primary endpoints included elevation of the basal HR (> 20%) and shortening of the Wenckebach cycle length (WCL) or the AH interval (> 20%). RESULTS: The immediate success rate of ablation of PVCs and PSVT in both groups was 100%. Compared with those in the control group, patients in the CNA group showed significant improvement in WCL, corrected sinus node recovery time (cSNRT), mean HR, minimum HR, and DC (404.55 ± 71.80 vs. 489.27 ± 85.63; 359.15 ± 52.29 vs. 409.34 ± 59.73; 68.58 ± 8.11 vs. 56.64 ± 4.15; 46.20 ± 4.67 vs. 41.27 ± 3.25; 5.38 (4.23, 6.32) vs. 8.88 (7.17, 9.93), respectively; p < 0.05). More importantly, the incidence of syncope in the CNA group was significantly lower (p = 0.032 < 0.05), and the improvement in quality of life was greater and more extensive in the CNA group. CONCLUSION: The simplified right atrial Ao-SVC GP ablation effectively treats vagal bradycardia. Additionally, combining it with radiofrequency ablation for concurrent tachyarrhythmia offers a safe and innovative therapy.