What does this research mean for the field?

Cardioneuroablation is effective and safe for treating functional bradyarrhythmia, with a pooled recurrence rate of 13.1% and a complication rate of 1.0%. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

The study aims to evaluate the efficacy and safety of cardioneuroablation in treating functional bradyarrhythmia.

February 28, 2026Open Access

Efficacy and safety of cardioneuroablation as a treatment for patients with functional bradyarrhythmia: a systematic review and meta-analysis

Key Result

Cardioneuroablation showed a 13.1% bradyarrhythmia recurrence rate and 1.0% complication rate in 482 patients, suggesting it is effective and safe with low certainty evidence.

Key Points

The study aims to evaluate the efficacy and safety of cardioneuroablation in treating functional bradyarrhythmia.
Systematic review and meta-analysis of observational studies
Nineteen studies included, involving 482 patients with functional bradyarrhythmia
Pooled analysis of recurrence and complication rates using a random effects model
Subgroup analyses conducted for different types of bradyarrhythmia and techniques
Pooled recurrence rate of 13.1% over a mean follow-up of 16.3 months
Pooled complication rate was low at 1.0%
Lower recurrence rates observed in functional sinus node dysfunction and biatrial ablation
No significant differences in techniques for identifying ganglionated plexi
Trends towards increased heart rate and shorter sinus node recovery time after CNA

Structured PICO

Does cardioneuroablation reduce recurrence and complications in patients with functional bradyarrhythmia?

Population

19 observational studies pooling 482 patients with functional bradyarrhythmia (including functional sinus node dysfunction [SND] and atrioventricular block [AVB]), mean age 38.1 ± 5.1 years, 55.7% male.

Intervention

Cardioneuroablation (CNA)

Outcome

Recurrence rate and complication rate over a mean follow-up of 16.3 ± 3.6 monthshard clinical

Cardioneuroablation demonstrates promising efficacy and safety for functional bradyarrhythmia with a 13.1% recurrence rate and 1.0% complication rate, though current evidence relies on low-certainty observational data.

Main Result

Absolute Event Rate: 0% vs 0%

Abstract

Cardioneuroablation (CNA) is a novel procedure that shows promising results in patients with functional bradyarrhythmia, including functional sinus node dysfunction (SND) and atrioventricular block (AVB). We performed a systematic review and meta -analysis to evaluate the efficacy and safety of CNA in this population. PubMed, Embase and Web of Science were searched from January 2005 to August 2025 following PRISMA guidelines. A single-arm proportion meta-analysis was performed using a random effects model. Nineteen observational studies comprising 482 patients with functional bradyarrhythmia who underwent CNA were included (mean age 38.1 ± 5.1 years; 55.7% male). Over a mean follow-up of 16.3 ± 3.6 months, the pooled recurrence rate was 13.1% (95% confidence interval CI 9.5% − 17.8%; I 2 = 0%) and the pooled complication rate was 1.0% (95% CI 0.1% − 9.1%; I 2 = 0%). Subgroup analyses suggested lower recurrence rates with functional SND (9.7% 6.3%-14.6%; I 2 = 0%), biatrial ablation (11.0% 6.7%-17.5%; I 2 = 10.7%), and the use of extracardiac noncontact vagal stimulation (ECVS) (8.3% 2.7%–22.9%; I 2 = 0%). No significant differences were observed among techniques used to identify ganglionated plexi (p = 0.938). Data synthesis indicated a non-significant trend towards increased heart rate, as well as shorter sinus node recovery time (SNRT) and corrected SNRT after CNA. These findings support that CNA may be effective and safe in functional SND and AVB; however, the overall certainty of evidence is low, and larger, well-designed clinical trials are required to inform future guideline recommendations.