{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T14:38:51Z","timestamp":1780324731303,"version":"3.54.1"},"reference-count":22,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2023,11,29]],"date-time":"2023-11-29T00:00:00Z","timestamp":1701216000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Background<\/jats:title><jats:p>Cardioneuroablation (CNA) is recognized as a promising therapeutic option for adults with severe symptomatic bradycardia caused by excessive vagal tone. However, no pediatric cases have been reported to date. Therefore, the aim of this study is to evaluate the feasibility and efficacy of CNA in children.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>A 12-year-old male patient was hospitalized with symptoms of fatigue, palpitations, and syncope for more than 2 months, and was definitively diagnosed with functional sinoatrial node dysfunction by using a 12-lead electrocardiogram, 24-h Holter monitoring, loading dose of atropine test (0.04\u2005mg\/kg), and treadmill exercise test. Simultaneously, whole-exome sequencing was performed on the child and his core family members. After completing the preoperative examination and signing the informed consent form, the child underwent CNA therapy.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>First, the electroanatomic structures of both atria were mapped out by using the Carto 3 system, according to the protocol of purely anatomy-guided and local fractionated intracardiac electrogram\u2013guided CNA methods. Then, the local fractionated intracardiac electrograms of each cardiac ganglionated plexus (GP), including the GP between the aortic root and the medial wall of the superior vena cava, the GP between the posterior wall of the coronary sinus ostium and the left atrium, the GP between the anterior antrum of the right superior pulmonary vein and the superior vena cava, the GP in the superolateral area around the root of the left superior pulmonary vein, the GP around the root of the right inferior pulmonary vein, and the GP around the root of the left inferior pulmonary vein, were used as targets for ablation at a power of 30\u2005W with an ablation index of 350\u2013400. At a 6-month follow-up, the child's heart rhythm saw a complete restoration to sinus rhythm and clinical symptoms disappeared.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The first application of CNA in a child with symptomatic sinus bradycardia was achieved with better clinical outcomes. CNA can be carried out cautiously in children under suitable indications.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2023.1290482","type":"journal-article","created":{"date-parts":[[2023,11,29]],"date-time":"2023-11-29T04:53:58Z","timestamp":1701233638000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":5,"title":["Cardioneuroablation for successful treatment of symptomatic bradycardia in a 12-year-old child after a 6-month follow-up"],"prefix":"10.3389","volume":"10","author":[{"given":"Xin","family":"Xu","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shuang","family":"He","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qian","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruixi","family":"Liu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lei","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Weijie","family":"Chen","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuehui","family":"Yin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiewei","family":"Lu","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2023,11,29]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"e382","DOI":"10.1161\/CIR.0000000000000628","article-title":"2018 ACC\/AHA\/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay: a report of the American College of Cardiology\/American Heart Association task force on clinical practice guidelines and the Heart Rhythm Society [published correction appears in Circulation 2019 Aug 20;140(8):e506-e508]","volume":"140","author":"Kusumoto","year":"2019","journal-title":"Circulation"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1883","DOI":"10.1093\/eurheartj\/ehy037","article-title":"2018 ESC guidelines for the diagnosis and management of syncope","volume":"39","author":"Brignole","year":"2018","journal-title":"Eur Heart J"},{"key":"B3","doi-asserted-by":"publisher","first-page":"1167","DOI":"10.1016\/j.cjca.2019.12.023","article-title":"Canadian cardiovascular society clinical practice update on the assessment and management of syncope","volume":"36","author":"Sandhu","year":"2020","journal-title":"Can J Cardiol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.eupc.2004.10.003","article-title":"\u201cCardioneuroablation\u201d\u2013new treatment for neurocardiogenic syncope, functional AV block and sinus dysfunction using catheter RF-ablation","volume":"7","author":"Pachon","year":"2005","journal-title":"Europace"},{"key":"B5","doi-asserted-by":"publisher","first-page":"279","DOI":"10.1161\/CIRCEP.111.966465","article-title":"Endocardial autonomic denervation of the left atrium to treat vasovagal syncope: an early experience in humans","volume":"5","author":"Yao","year":"2012","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"B6","doi-asserted-by":"publisher","first-page":"188","DOI":"10.3390\/jcdd9060188","article-title":"Extracardiac vagal stimulation-assisted cardioneuroablation: dynamically evaluating the impact of sequential ganglionated plexus ablation on vagal control of SAN and AVN in patients with sinoatrial node dysfunction","volume":"9","author":"Chen","year":"2022","journal-title":"J Cardiovasc Dev Dis"},{"key":"B7","doi-asserted-by":"publisher","first-page":"42","DOI":"10.1111\/pace.12756","article-title":"Simplified cardioneuroablation in the treatment of reflex syncope, functional AV block, and sinus node dysfunction","volume":"39","author":"Aksu","year":"2016","journal-title":"Pacing Clin Electrophysiol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"252","DOI":"10.1016\/j.amjms.2017.11.016","article-title":"Catheter ablation of bradyarrhythmia: from the beginning to the future","volume":"355","author":"Aksu","year":"2018","journal-title":"Am J Med Sci"},{"key":"B9","doi-asserted-by":"publisher","first-page":"904","DOI":"10.1136\/heartjnl-2012-303220","article-title":"Vagally mediated atrioventricular block: pathophysiology and diagnosis","volume":"99","author":"Alboni","year":"2013","journal-title":"Heart"},{"key":"B10","doi-asserted-by":"publisher","first-page":"1279","DOI":"10.1161\/CIRCRESAHA.120.318458","article-title":"Innervation and neuronal control of the mammalian sinoatrial node a comprehensive atlas","volume":"128","author":"Hanna","year":"2021","journal-title":"Circ Res"},{"key":"B11","doi-asserted-by":"publisher","first-page":"353","DOI":"10.1002\/1097-0185(20000801)259:4%3C353::AID-AR10%3E3.0.CO;2-R","article-title":"Morphology, distribution, and variability of the epicardiac neural ganglionated subplexuses in the human heart","volume":"259","author":"Pauza","year":"2000","journal-title":"Anat Rec"},{"key":"B12","doi-asserted-by":"publisher","first-page":"569","DOI":"10.1016\/j.jacep.2018.03.006","article-title":"Clinical spectrum of SCN5A mutations: long QT syndrome, Brugada syndrome, and cardiomyopathy","volume":"4","author":"Wilde","year":"2018","journal-title":"JACC Clin Electrophysiol"},{"key":"B13","doi-asserted-by":"publisher","first-page":"1019","DOI":"10.1172\/JCI18062","article-title":"Congenital sick sinus syndrome caused by recessive mutations in the cardiac sodium channel gene (SCN5A)","volume":"112","author":"Benson","year":"2003","journal-title":"J Clin Invest"},{"key":"B14","doi-asserted-by":"publisher","first-page":"654925","DOI":"10.3389\/fgene.2021.654925","article-title":"Genetic complexity of sinoatrial node dysfunction","volume":"12","author":"Wallace","year":"2021","journal-title":"Front Genet"},{"key":"B15","doi-asserted-by":"publisher","first-page":"117","DOI":"10.1111\/jce.15278","article-title":"Procedural and short-term results of electroanatomic-mapping-guided ganglionated plexus ablation by first-time operators: a multicenter study","volume":"33","author":"Aksu","year":"2022","journal-title":"J Cardiovasc Electrophysiol"},{"key":"B16","doi-asserted-by":"publisher","first-page":"e010018","DOI":"10.1161\/CIRCEP.121.010018","article-title":"Cardioneuroablation for treatment of atrioventricular block","volume":"14","author":"Aksu","year":"2021","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"B17","doi-asserted-by":"publisher","first-page":"77","DOI":"10.1007\/s10840-020-00938-0","article-title":"The benefit of cardioneuroablation to reduce syncope recurrence in vasovagal syncope patients: a case-control study","volume":"63","author":"Aksu","year":"2022","journal-title":"J Interv Card Electrophysiol"},{"key":"B18","doi-asserted-by":"publisher","first-page":"1056","DOI":"10.1016\/j.jacep.2016.12.027","article-title":"Cardio-neuromodulation: the right-sided approach","volume":"3","author":"Debruyne","year":"2017","journal-title":"JACC Clin Electrophysiol"},{"key":"B19","doi-asserted-by":"publisher","first-page":"e006604","DOI":"10.1161\/CIRCEP.118.006604","article-title":"Unifocal right-sided ablation treatment for neurally mediated syncope and functional sinus node dysfunction under computed tomographic guidance","volume":"11","author":"Debruyne","year":"2018","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"B20","doi-asserted-by":"publisher","first-page":"57","DOI":"10.1007\/s10840-020-00704-2","article-title":"Medium-term results of cardioneuroablation for clinical bradyarrhythmias and vasovagal syncope: effects on QT interval and heart rate","volume":"60","author":"Aksu","year":"2021","journal-title":"J Interv Card Electrophysiol"},{"key":"B21","doi-asserted-by":"publisher","first-page":"e008703","DOI":"10.1161\/CIRCEP.120.008703","article-title":"Long-term evaluation of the vagal denervation by cardioneuroablation using Holter and heart rate variability","volume":"13","author":"Pachon-M","year":"2020","journal-title":"Circ Arrhythm Electrophysiol"},{"key":"B22","doi-asserted-by":"publisher","first-page":"444","DOI":"10.1016\/j.jtcvs.2009.04.056","article-title":"Vagal denervation and reinnervation after ablation of ganglionated plexi","volume":"139","author":"Sakamoto","year":"2010","journal-title":"J Thorac Cardiovasc Surg"}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2023.1290482\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,11,29]],"date-time":"2023-11-29T04:54:01Z","timestamp":1701233641000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2023.1290482\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,11,29]]},"references-count":22,"alternative-id":["10.3389\/fcvm.2023.1290482"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2023.1290482","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,11,29]]},"article-number":"1290482"}}