Complications of Cardioneuroablation: A Comprehensive Review and Institutional Experience

Cardioneuroablation (CNA) has emerged as a therapeutic option for functional bradyarrhythmias and reflex syncope, achieved through parasympathetic denervation via atrial ganglionated plexi ablation. Although efficacy data are encouraging, safety evidence remains limited and heterogeneous. We performed a comprehensive review of complications associated with CNA and integrated these findings with a single-centre experience of 377 consecutive procedures performed in the Institute for Clinical and Experimental Medicine, Prague, Czech Republic, between 2014 and 2026. Reported complications were infrequent and included vascular access complications, pericardial effusion, phrenic nerve injury, coronary artery injury, transient sinus node dysfunction and atrioventricular conduction disturbances. Post-procedural manifestations related to autonomic modulation included inappropriate sinus tachycardia, reduced exercise tolerance and occasional atrial arrhythmias, whereas the impact on ventricular arrhythmogenesis remains uncertain. In our institutional cohort, the overall major complication rate was 1.9% (7/377), including 0.3% (1/377) requiring intervention. No complication resulted in permanent damage or sequelae. CNA appears to have an acceptable safety profile in experienced centres, although complications are probably underrecognised or underreported and long-term prospective data are needed.