PO-04-033 CARDIONEUROABLATION IN A WOMAN WITH ICTAL-INDUCED CARDIAC ASYSTOLE

Ictal-induced cardiac bradyarrhythmia and asystole is a rare phenomenon. The exact mechanism of ictal-induced remains unclear. It was postulated that stimulation central autonomic network during ictal episode may trigger an abrupt burst hypervagotonia. Prolonged result in syncope or death due to impairment cerebral perfusion. role cardioneuroablation (CNA) this condition has not been well-described the literature. To describe case successful CNA patient with asystole. n/a A 47-year-old female 1.5-year history intractable focal epilepsy COVID-19 infection. She started having multiple episodes seizures following mild Electroencephalogram (EEG) brain MRI revealed right temporal onset without structural lesions. Due ongoing uncontrolled semiologies despite anti-epileptic drugs, she admitted Epilepsy Monitoring Unit for seizure classification. Her EEGs (Figure 1) showed rhythm region severe sinus bradycardia (15-30 bpm) pauses (15-16 seconds). Telemetry tracings demonstrated PP interval slowing PR prolongation prior consistent vagally-mediated mechanism. Cardiac electrophysiology team recommended treating 3D anatomic maps atrium (RA) left (LA) were created using CARTO system (Biosense Webster). Right superior ganglionated plexus (RSGP) localized fractionation mapping intracardiac echocardiography guidance. RSGP targeted from RA irrigated radiofrequency catheter power limit 25 W. Post-ablations RSGP, her heart rate increased 60 - 99 bpm. Additional lesions delivered LA site but no additional increase seen. An implantable loop recorder implanted post-ablation procedure. During follow-up 8 months, had recurrent epilepsy, bradyarrhythmias noted on recorder. Resting rates at long-term follow up between 70 100 This highlights utility be approach avoid permanent pacemakers population.