Biatrial cardioneuroablation was feasible, safe, and improved freedom from syncope or bradyarrhythmia without pacemaker implantation compared to medical management over 12 months of follow-up.
Observational (n=22)
Does biatrial cardioneuroablation improve freedom from syncope or clinically significant bradyarrhythmia without pacemaker implantation compared to medical management in patients with drug-refractory vagally mediated bradyarrhythmias?
Biatrial cardioneuroablation guided by robotic magnetic navigation and AI mapping appears safe and effective for reducing syncope and pacemaker implantation in patients with refractory vagally mediated bradyarrhythmias.
PURPOSE: Reflex bradyarrhythmias and syncope related to excessive vagal tone may be refractory to conservative therapy and significantly impair quality of life. Cardioneuroablation (CNA) has emerged as a device-sparing alternative, but real-world outcome data remain limited. METHODS: We retrospectively evaluated 12 consecutive patients (aged 23-55 years) with drug-refractory, vagally mediated bradyarrhythmias confirmed by tilt-table testing. All underwent biatrial CNA guided by ultra-high-density electroanatomical mapping with automated fragmented-electrogram detection and robotic magnetic navigation. A contemporaneous cohort of medically managed patients with comparable clinical profiles (n = 10) served as a control group. The primary outcome was freedom from syncope or clinically significant bradyarrhythmia without pacemaker implantation. Secondary outcomes included procedural metrics, heart-rate changes, and recurrence during follow-up. RESULTS: All CNA procedures were completed without acute complications and with minimal fluoroscopy exposure. Resting sinus rate increased substantially after ablation. Over a mean follow-up of approximately 12 months, most CNA-treated patients remained free of symptomatic bradyarrhythmia or syncope without requiring pacemaker implantation, whereas recurrence and pacemaker placement were less frequent compared with controls. No delayed complications were observed. CONCLUSIONS: In this small, retrospective real-world cohort, biatrial CNA guided by automated electrogram analysis and robotic navigation was feasible, safe, and associated with short-term autonomic modulation and symptomatic improvement over approximately 12 months of follow-up in selected patients with vagally mediated bradyarrhythmias. These findings are exploratory and warrant confirmation in larger, prospective studies with longer follow-up to assess durability and reinnervation risk.
Crispo et al. (Sat,) conducted a observational in Drug-refractory, vagally mediated bradyarrhythmias (n=22). Biatrial cardioneuroablation (CNA) vs. Medical management was evaluated on Freedom from syncope or clinically significant bradyarrhythmia without pacemaker implantation. Biatrial cardioneuroablation was feasible, safe, and improved freedom from syncope or bradyarrhythmia without pacemaker implantation compared to medical management over 12 months of follow-up.