What does this research mean for the field?

Right atrial cardioneuroablation reduced asystolic episodes by 88% and syncopal episodes by 76% during median follow-up of 12.5 months, with minimal adverse events. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

February 8, 2026European Heart Journal

Right atrial cardioneuroablation of asystolic reflex syncope-insights from ItalianCNA

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Key result

Right atrial cardioneuroablation linked to an ~88% reduction in asystolic episodes and fewer syncopal events.

Why the study?

The study was conducted to evaluate the efficacy and safety of right atrial cardioneuroablation in patients with asystolic reflex syncope.

Does right atrial cardioneuroablation reduce asystolic and syncopal episodes in patients with severe asystolic reflex syncope?

Population

28 patients with severe, asystolic reflex syncopes identified by ILR

Comparison

Right atrial cardioneuroablation with pre- vs post-ablation monitoring

Design

Observational cohort study

Follow-up

Median 12.5 months

Authors

MTMarco TomainoElectrophysiology LCL Calo'Foro Italico University of Rome MRM RebecchiPoliclinico Casilino

Discussion

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Implication

May support right atrial CNA in severe asystolic reflex syncope; hypothesis-generating pending randomized confirmation.

Key Points

This research aims to assess the efficacy and safety of right atrial cardioneuroablation in treating asystolic reflex syncope.
Patients with severe asystolic reflex syncopes identified by implantable loop recorder underwent right atrial CNA ablation.
The cohort consisted of 28 patients with a mean age of 40.5 years, predominantly male.
Patients were monitored after ablation using implantable loop recorders for a median follow-up of 12.5 months.
Asystolic episodes decreased from 0.89 to 0.11 episodes per month, representing an 88% reduction.
Syncopal episodes reduced from 0.23 to 0.06 episodes per month, showing a 76% reduction.
Median heart rate increased from 75 bpm before to 83 bpm after the procedure, lasting up to 9 months.
No complications during the procedure; mild symptoms were transient and did not require therapy.

Structured PICO

Does right atrial cardioneuroablation reduce asystolic and syncopal episodes in patients with severe asystolic reflex syncope?

Population

28 patients with severe, asystolic reflex syncopes identified by implantable loop recorder (ILR), mean age 40.5±13.4 years, 71% male.

Intervention

Right atrial cardioneuroablation (CNA)

Comparator

Pre-ablation baseline (before CNA)

Outcome

Burden of asystolic episodes (episodes per month) and burden of syncopal episodeshard clinical

Right atrial cardioneuroablation significantly reduces the burden of asystolic and syncopal episodes in patients with severe asystolic reflex syncope, with a low rate of adverse events.

Cite This Study

Tomaino et al. (2025) studied this question. Right atrial cardioneuroablation reduced asystolic episodes by 88% and syncopal episodes by 76% over 12.5 months with few mild adverse events.

synapsesocial.com/papers/6988278b0fc35cd7a88466b6 https://doi.org/10.1093/eurheartj/ehaf784.801

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Right atrial cardioneuroablation of asystolic reflex syncope-insights from ItalianCNA

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

Right atrial cardioneuroablation of asystolic reflex syncope-insights from ItalianCNA

Discussion

Member takes

Implication

Key Points

Structured PICO

Cite This Study

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