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CASE REPORT article

Front. Cardiovasc. Med.
Sec. Cardiac Rhythmology
Volume 11 - 2024 | doi: 10.3389/fcvm.2024.1453166

Cardioneuroablation eliminating cardiac asystole associated with area postrema syndrome: a case report and literature review

Provisionally accepted
EnRun Wang EnRun Wang 1YuanJing Li YuanJing Li 1Gang Yu Gang Yu 2Gang Liu Gang Liu 1Jiang Deng Jiang Deng 1YanFei Wang YanFei Wang 1Wei Yang Wei Yang 1GuoDong Chen GuoDong Chen 1Dennis W. Zhu Dennis W. Zhu 3Fengpeng Jia Fengpeng Jia 1*
  • 1 Department of Cardiovascular Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, China
  • 2 Department of Neurology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
  • 3 Cardiac Electro-Physiology Laboratories, Regions Hospital, St. Paul, Minnesota, United States

The final, formatted version of the article will be published soon.

    Background: There have been few instances of symptomatic bradycardia-arrhythmia in the context of area postrema syndrome (APS), and some of them have been implanted permanent pacemakers. Cardioneuroablation (CNA) has emerged as a viable therapy for the treatment of syncope induced by neutrally mediated bradycardia or atrioventricular block. Methods: We report a young patient with recurrent cardiac asystole and syncope following persistent hiccups caused by neuromyelitis optica spectrum disorder (NMOSD), who successfully completed CNA treatment and avoided permanent pacemaker placement. We also summarized and analyzed 20 previously reported cases that were relevant to APS with bradyarrhythmia. Results: In a patient with NMOSD, CNA can efficiently and safely eradicate symptomatic bradycardia-arrhythmia. A total of 21 cases were identified in the final analysis (including our case). The average age was 51 years old and female patients accounted for 38.1%. Brady-arrhythmia was presented in all patients, and 9 patients were implanted temporary or permanent pacemakers. 4 of the 9 patients were received permanent pacing therapy because they were not weaned off pacing support after etiological treatment. Conclusions: Cardiac asystole and syncope after persistent hiccups may be the first signs of APS of medullary lesions, and CNA may be a useful therapy option for these patients in experienced centers. We believe that in this scenario, CNA may be a superior therapeutic option than permanent pacemaker placement. Additionally, the statement also serves as a cautionary reminder for health care professionals to establish an association between bradyarrhythmia and APS of medullary lesions in their clinical practice.

    Keywords: Cardioneuroablation, Asystole, NMOSD, Medullary lesions, case report

    Received: 24 Jun 2024; Accepted: 21 Oct 2024.

    Copyright: © 2024 Wang, Li, Yu, Liu, Deng, Wang, Yang, Chen, Zhu and Jia. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.

    * Correspondence: Fengpeng Jia, Department of Cardiovascular Medicine, First Affiliated Hospital of Chongqing Medical University, Chongqing, China

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