Key result
Cardioneuroablation for cardioinhibitory syncope shows a ~4% recurrence rate and increases mean heart rate.
Why the study?
Cardioneuroablation offers a novel treatment option for recurrent vasovagal syncope or carotid sinus syndrome resistant to medical therapy, but further evaluation of clinical, electrophysiological, and autonomic outcomes was needed.
Does cardioneuroablation improve heart rate and prevent syncope recurrence in patients with recurrent, drug-refractory vasovagal syncope or carotid sinus syndrome?
Cohort (n=71)
No
Does cardioneuroablation improve heart rate and prevent syncope recurrence in patients with recurrent, drug-refractory vasovagal syncope or carotid sinus syndrome?
Answers are grounded in this paper and cite their sources.
Cardioneuroablation is a safe and highly effective interventional strategy that significantly increases resting heart rate and prevents syncope recurrence in patients with refractory cardioinhibitory syncope.
Background Cardioneuroablation (CNA) aims to modulate excessive parasympathetic tone by targeting atrial ganglionated plexi, offering a novel treatment option for recurrent vasovagal syncope (VVS) or carotid sinus syndrome (CSS) resistant to medical therapy. This study evaluated clinical, electrophysiological, and autonomic outcomes in patients who underwent CNA at our center, together with long-term follow-up data. Methods Seventy-one patients (mean age 39.7 ± 15.2 years, 43.7% male) who underwent CNA between January 2020 and June 2025 due to recurrent VVS or CSS were retrospectively analyzed. Ablations were applied to the left superior (LSGP), left inferior (LIGP), Marshall tract (MTGP), right superior (RSGP), right inferior (RIGP), and posteromedial left atrial (PMLGP) plexi (mean 29 ± 6 points). Electrophysiological parameters, atropine test response, and mean heart rate changes on 12-month Holter monitoring were compared. Syncope recurrence and pacemaker (PPM) implantation rates were recorded. Results Pre-procedural mean heart rate was 63.7 ± 7.2 bpm, increasing to 83.6 ± 11.4 bpm at 12 months (p < 0.001). Mean AH and HV intervals were 62.4 ± 13.3 ms and 48.8 ± 8.5 ms, respectively. Corrected sinus node recovery time averaged 482.4 ± 73.9 ms, and Wenckebach cycle length 372.1 ± 55.7 ms. Procedural success rate was 97.2%. During a mean follow-up of 15.9 ± 5.0 months, syncope recurred in 3 (4.2%) patients and PPM implantation was required in 2 (2.8%). No major complications occurred. Conclusion CNA effectively restores autonomic balance by reducing parasympathetic overactivity, resulting in sustained symptom relief in recurrent cardioinhibitory syncope. Significant post-procedural heart-rate increase and normalization of atropine response confirm functional denervation. The high procedural success and low complication rates demonstrate CNA’s safety and efficacy. These findings support CNA as a promising interventional option in patients with recurrent, drug-refractory VVS.
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Belpinar et al. (2026) conducted a cohort in recurrent vasovagal syncope (VVS) or carotid sinus syndrome (CSS) (n=71). Cardioneuroablation was evaluated on syncope recurrence. Cardioneuroablation for recurrent cardioinhibitory syncope resulted in a 4.2% syncope recurrence rate over 15.9 months and increased mean heart rate to 83.6 bpm at 12 months (p<0.001).
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