{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T23:54:13Z","timestamp":1785801253148,"version":"3.56.0"},"reference-count":23,"publisher":"Oxford University Press (OUP)","issue":"12","license":[{"start":{"date-parts":[[2025,11,18]],"date-time":"2025-11-18T00:00:00Z","timestamp":1763424000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Anatomical studies have documented a close topographical relationship between the ganglionated plexi (GP) containing parasympathetic inputs to the sinus node (SN) and atrioventricular node (AVN) and the epicardial fat pads (FPs) within the Waterston\u2019s interatrial groove. We aimed to investigate the feasibility and outcomes of a novel anatomical approach to cardioneuroablation (CNA) that targets the atrial areas adjacent to the interatrial FPs identified with intracardiac echocardiography (ICE).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>About 17 patients [37.3 \u00b1 10.2 years, 47% female] undergoing CNA for recurrent vasovagal syncope and documented sinus pauses (n = 13, 76%) and\/or AVN block (AVB, n = 4, 16%) were included. The right superior RS-FP containing the RS-GP (target for SN vagal denervation) and the right inferior RI-FP containing the RI-GP (target for AVN vagal denervation) were identified with ICE and reconstructed on a 3D electroanatomic map. At baseline, all patients had provocable sinus pauses\/AVB with extracardiac high-frequency vagal stimulation (ECVS). The target FPs could be identified in all patients and were adjacent to septal LA and RA sites covering an average surface area of 3.7 \u00b1 1.4\u2005cm2 and 2.97 \u00b1 1.21\u2005cm2, respectively. A total of 33 \u00b1 15 RF ablations (30\u201340W, 60\u2005s) were delivered to cover the target LA\/RA area. A &amp;gt; 25% shortening of the PP interval was observed within the first 1\u20132 RF lesions in all cases. After ablation, complete abolition of sinus pauses\/AVB response with ECVS was achieved in all patients, and 2\u2005mg of atropine infusion resulted in no PP\/PR interval change. After a median follow-up of 12 months (range 4\u201325 months), 16 patients (94%) remained free of recurrent symptoms (1 patient underwent repeat CNA for recurrent pre-syncope and AVB, 1 patient underwent PPM implant following ECG recording of asymptomatic diurnal AVB).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>An ICE-guided anatomical approach to CNA targeting visible FPs at the Waterston\u2019s groove is a feasible and effective strategy to achieve SN\/AVN vagal denervation, with good outcomes at mid-term follow-up.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/europace\/euaf295","type":"journal-article","created":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T12:27:46Z","timestamp":1763382466000},"source":"Crossref","is-referenced-by-count":5,"title":["Intracardiac echocardiography guided anatomical approach to cardioneuroablation: feasibility and outcomes"],"prefix":"10.1093","volume":"27","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9052-9690","authenticated-orcid":false,"given":"Medhat","family":"Farwati","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute , 9500 Euclid Ave., Cleveland Clinic, Cleveland, OH 44195 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8359-1525","authenticated-orcid":false,"given":"Ayman A","family":"Hussein","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute , 9500 Euclid Ave., Cleveland Clinic, Cleveland, OH 44195 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7313-7778","authenticated-orcid":false,"given":"Santiago","family":"Giraldo","sequence":"additional","affiliation":[{"name":"International Arrhythmia Center, Fundaci\u00f3n Cardioinfatil - La Cardio, Division of Cardiology , Bogota ,","place":["Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Bautista","sequence":"additional","affiliation":[{"name":"International Arrhythmia Center, Fundaci\u00f3n Cardioinfatil - La Cardio, Division of Cardiology , Bogota ,","place":["Colombia"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9218-1966","authenticated-orcid":false,"given":"Koji","family":"Higuchi","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute , 9500 Euclid Ave., Cleveland Clinic, Cleveland, OH 44195 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bryan","family":"Baranowski","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute , 9500 Euclid Ave., Cleveland Clinic, Cleveland, OH 44195 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mandeep","family":"Bhargava","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute , 9500 Euclid Ave., Cleveland Clinic, Cleveland, OH 44195 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5281-7598","authenticated-orcid":false,"given":"Thomas D","family":"Callahan","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute , 9500 Euclid Ave., Cleveland Clinic, Cleveland, OH 44195 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7835-6045","authenticated-orcid":false,"given":"Mina K","family":"Chung","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute , 9500 Euclid Ave., Cleveland Clinic, Cleveland, OH 44195 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6415-3880","authenticated-orcid":false,"given":"Roy","family":"Chung","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute , 9500 Euclid Ave., Cleveland Clinic, Cleveland, OH 44195 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2485-5025","authenticated-orcid":false,"given":"Arwa","family":"Younis","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute , 9500 Euclid Ave., Cleveland Clinic, Cleveland, OH 44195 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffery","family":"Courson","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute , 9500 Euclid Ave., Cleveland Clinic, Cleveland, OH 44195 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6711-7284","authenticated-orcid":false,"given":"Thomas J","family":"Dresing","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute , 9500 Euclid Ave., Cleveland Clinic, Cleveland, OH 44195 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0002-1419-1808","authenticated-orcid":false,"given":"Mohamed","family":"Kanj","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute , 9500 Euclid Ave., Cleveland Clinic, Cleveland, OH 44195 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Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute , 9500 Euclid Ave., Cleveland Clinic, Cleveland, OH 44195 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7370-6993","authenticated-orcid":false,"given":"Ioan","family":"Liuba","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute , 9500 Euclid Ave., Cleveland Clinic, Cleveland, OH 44195 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David O","family":"Martin","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute , 9500 Euclid Ave., Cleveland Clinic, Cleveland, OH 44195 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Cleveland Clinic, Cleveland, OH 44195 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3324-8611","authenticated-orcid":false,"given":"Walid I","family":"Saliba","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute , 9500 Euclid Ave., Cleveland Clinic, Cleveland, OH 44195 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2490-5106","authenticated-orcid":false,"given":"Jakub","family":"Sroubek","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Heart, Vascular, and Thoracic Institute , 9500 Euclid Ave., Cleveland Clinic, Cleveland, OH 44195 ,","place":["USA"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1258-8118","authenticated-orcid":false,"given":"Tyler 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