Key result
Cardioneuroablation cuts 2-year syncope recurrence by an absolute ~46% vs. controls.
Why the study?
This review aims to synthesize current knowledge regarding various cardioneuroablation techniques, exploring the associated mechanisms, clinical applications, and outcomes across diverse patient populations.
Does cardioneuroablation prevent syncope and avoid pacemaker implantation in patients with functional bradyarrhythmias and vasovagal syncope?
Does cardioneuroablation prevent syncope and avoid pacemaker implantation in patients with functional bradyarrhythmias and vasovagal syncope?
Cardioneuroablation is a promising, safe, and effective alternative to permanent pacemaker implantation for treating carefully selected patients with well-documented vagally mediated functional bradyarrhythmias.
May avoid pacemakers in select patients; extends one RCT but leaves durability and selection criteria open.
Cardioneuroablation (CNA) has emerged as a promising therapeutic strategy for functional bradyarrhythmias, particularly in cases of cardioinhibitory neurocardiogenic syncope and certain forms of atrial fibrillation. Indeed, by targeting vagal innervation through endocardial radiofrequency catheter ablation, CNA can obviate the need for pacemaker (PM) implantation. This technique involves denervation of specific vagal nerve structures within the atria to modulate autonomic balance and prevent symptomatic bradycardia. The efficacy of this approach stems from the recognition that an imbalance between sympathetic and parasympathetic tones, often characterized by excessive vagal activity, underpins these arrhythmogenic conditions. Indeed, CNA may be more effective than a permanent PM implantation in some patients, as this method addresses the underlying etiology rather than merely treating symptoms. Specifically, modulating autonomic nervous system (ANS) signaling through procedures such as CNA holds considerable promise for preventing and treating a range of cardiac arrhythmias. This review aims to synthesize current knowledge regarding various CNA techniques, exploring the associated mechanisms, clinical applications, and outcomes across diverse patient populations.
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Conti et al. (2026) conducted a review in Functional bradyarrhythmias and vasovagal syncope. Cardioneuroablation vs. Standard management or pacemaker implantation was evaluated. Cardioneuroablation effectively reduces recurrent functional bradyarrhythmias and vasovagal syncope, with an included randomized trial demonstrating an 8% syncope recurrence rate at 2 years compared to 54% in controls.
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