Fractionation mapping of the ganglionated plexi for cardioneuroablation

Leah A. John, Andin Mullis, Joshua Payne, Roderick Tung, Tolga Aksu, Jeffrey R. Winterfield

Research output: Contribution to journalArticlepeer-review


Cardioneuroablation (CNA) is an emerging technique used to treat patients with vasovagal syncope (VVS). We herein describe a case of CNA targeting the atrial ganglionated plexi (GPs) based upon anatomical landmarks and fractionated electrogram (EGM) localization in a 20-year-old healthy female who presented to our center with malignant VVS and symptomatic sinus pauses, the longest of which measured 10 seconds. She underwent acutely successful CNA with a demonstration of vagal response noted following ablation of the left-sided GPs, and tachycardia was noted with right-sided GP ablation. All GP sites were defined by anatomical landmarks and EGM analysis. By using the fractionation mapping software of the EnSite Precision™ cardiac mapping system (Abbott, Chicago, IL, USA) with high-density mapping, fragmented EGMs were successfully detected in each GP site. One month after vagal denervation, no recurrent syncopal episodes or sinus pauses had been recorded. Longer-term follow-up with an implantable loop recorder is planned. Broadly, we performed CNA in a patient with VVS by combining high-density mapping and fractionation mapping software in a novel approach, which allowed us to detect fractionation in all GP sites and demonstrate an acute vagal response. This workflow may facilitate the introduction of a standardized technique suitable for widespread use.

Original languageEnglish (US)
Pages (from-to)4473-4476
Number of pages4
JournalJournal of Innovations in Cardiac Rhythm Management
Issue number4
StatePublished - Apr 2021
Externally publishedYes


  • Cardioinhibitory
  • Cardioneuroablation
  • Ganglionated plexi
  • High-density mapping
  • Vasovagal syncope

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)


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