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Background <p>Cardioneuroablation (CNA) is an interventional technique targeting ganglionated plexi (GPs) to modulate autonomic tone in functional atrioventricular (AV) block and cardioinhibitory vasovagal syncope. This study evaluates fractionated area mapping and peak frequency area mapping in localizing autonomic targets and regional variations in peak frequency distributions across predefined cardiac segments in patients undergoing CNA.</p> Methods <p>A retrospective analysis was conducted on 10 patients with cardioinhibitory vasovagal syncope (<i>n</i> = 7) and functional AV block (<i>n</i> = 3). High-density electroanatomical mapping (EAM) assessed fractionated areas and peak frequency (&gt; 550&#xa0;Hz) areas across 22 predefined cardiac regions.</p> Results <p>The median fractionated area was 0.8 cm<sup>2</sup> (0.3–1.6 cm<sup>2</sup>), while the median area for regions with peak frequency &gt; 550&#xa0;Hz was 0.6 cm<sup>2</sup> (0.3–1.0 cm<sup>2</sup>, <i>p</i> = 0.152). The median peak frequency at the left superior GP, where asystole or bradycardia responses occurred, was 623.0&#xa0;Hz (582.0–668.0&#xa0;Hz), while in regions with tachycardia responses, it was 602.0&#xa0;Hz (582.0–668.0&#xa0;Hz, <i>p</i> = 0.738). Ablation sites overlapped both mapping areas in seven patients, while two had sites limited to peak frequency areas. Peak frequency values were highest in the septal and posterior atrial walls, superior vena cava, and GP regions, indicating heightened autonomic activity.</p> Conclusion <p>Fractionated area and peak frequency (&gt; 550&#xa0;Hz) mapping provide complementary insights into CNA targets. Regional peak frequency variations highlight autonomic differences, supporting multi-mapping integration for procedural precision and improved outcomes.</p> Graphical Abstract <p></p>

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Enhanced mapping and targeting of ganglionated plexi using peak frequency analysis in cardioneuroablation: a study in autonomic cardiac disorders

  • 期刊论文

  • 发表日期：

    2025年10月10日

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  • Sukriye Ebru Onder,
  • Tumer Erdem Guler,
  • Serdar Bozyel,
  • Metin Cagdas,
  • Aziz İnan Celik,
  • Sadiye Nur Dalgic,
  • Abdulcebbar Sipal,
  • Ahmet Berk Duman,
  • Emre Kılıc,
  • Henry D. Huang,
  • Tolga Aksu

摘要

Background

Cardioneuroablation (CNA) is an interventional technique targeting ganglionated plexi (GPs) to modulate autonomic tone in functional atrioventricular (AV) block and cardioinhibitory vasovagal syncope. This study evaluates fractionated area mapping and peak frequency area mapping in localizing autonomic targets and regional variations in peak frequency distributions across predefined cardiac segments in patients undergoing CNA.

Methods

A retrospective analysis was conducted on 10 patients with cardioinhibitory vasovagal syncope (n = 7) and functional AV block (n = 3). High-density electroanatomical mapping (EAM) assessed fractionated areas and peak frequency (> 550 Hz) areas across 22 predefined cardiac regions.

Results

The median fractionated area was 0.8 cm2 (0.3–1.6 cm2), while the median area for regions with peak frequency > 550 Hz was 0.6 cm2 (0.3–1.0 cm2, p = 0.152). The median peak frequency at the left superior GP, where asystole or bradycardia responses occurred, was 623.0 Hz (582.0–668.0 Hz), while in regions with tachycardia responses, it was 602.0 Hz (582.0–668.0 Hz, p = 0.738). Ablation sites overlapped both mapping areas in seven patients, while two had sites limited to peak frequency areas. Peak frequency values were highest in the septal and posterior atrial walls, superior vena cava, and GP regions, indicating heightened autonomic activity.

Conclusion

Fractionated area and peak frequency (> 550 Hz) mapping provide complementary insights into CNA targets. Regional peak frequency variations highlight autonomic differences, supporting multi-mapping integration for procedural precision and improved outcomes.

Graphical Abstract