Key result
Cardioneuroablation linked to syncope elimination and a ~17-bpm increase in mean heart rate.
Why the study?
The clinical efficacy and safety of cardioneuroablation in patients with vagally-mediated dysfunction of sinus and AV nodes were not well established.
Cohort (n=21)
No
Cardioneuroablation is a feasible catheter-based procedure that significantly improves heart rate, electrophysiological parameters, and health-related quality of life in selected patients with vagally-mediated bradyarrhythmias, potentially avoiding the need for permanent pacemakers.
Cardioneuroablation was associated with syncope resolution in this cohort; leaves open its role pending randomized trials before practice change.
Aim: To assess the clinical efficacy and safety of cardioneuroablation (CNA) in patients with vagally-mediated dysfunction of sinus and atrioventricular (AV) nodes. Methods: Between August 2023 and March 2025, 21 CNA procedures were performed in patients with autonomic dysfunction of the sinus node and functional second- and third-degree AV block. Clinical follow-up assessments were conducted at 3, 6, 12, and 24 months post-procedure, including 24-hour Holter monitoring and validated quality-of-life questionnaires. Results: A total of 21 patients (mean age 37.4 ± 10.2 years) were included. CNA resulted in a significant increase in mean heart rate (HR) from 53.2 ± 9.6 beats per minute (bpm) to 70.4 ± 7.8 bpm (mean difference +17.1 bpm; 95% confidence interval [CI]: 13.5-20.8; p < 0.001; Cohen’s d = 2.13). Significant improvement in antegrade AV conduction (Wenckebach point: 541.9 ± 139.9 to 393.8 ± 63.7 ms; p < 0.001; d = 1.34) and corrected sinus node recovery time (cSNRT: 524.5 ± 273.1 to 320.5 ± 76.9 ms; p = 0.030) was observed. PR, AH, and HV intervals showed no significant changes (all p > 0.05). All six patients with prior syncope remained syncope-free throughout follow-up. Statistically significant improvement was observed in all five EQ-5D domains (p ≤ 0.025). Conclusion: In selected patients with confirmed vagally mediated bradyarrhythmias, CNA is a feasible catheter-based procedure that may reduce the need for permanent pacemaker implantation. These preliminary results from a single-center pilot cohort study demonstrate significant improvement in HR, electrophysiological parameters, and health-related quality of life. Confirmation in larger multicenter controlled studies is required before broader clinical implementation.
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Смагулов et al. (2026) conducted a cohort in Vagally-mediated bradyarrhythmia (n=21). Cardioneuroablation vs. Baseline was evaluated on Freedom from syncope or presyncope attributable to vagally mediated bradycardia and absence of clinically significant bradycardia. Cardioneuroablation completely eliminated syncope in affected patients and significantly increased mean heart rate by 17.1 bpm (p < 0.001), though two patients ultimately required permanent pacemakers.
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