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. 2023 May 19;25(5):euad033.
doi: 10.1093/europace/euad033.

Clinical controversy: methodology and indications of cardioneuroablation for reflex syncope

Michele Brignole  1 , Tolga Aksu  2 , Leonardo Calò  3 , Philippe Debruyne  4 , Jean Claude Deharo  5 , Alessandra Fanciulli  6 , Artur Fedorowski  7   8   9 , Piotr Kulakowski  10 , Carlos Morillo  11 , Angel Moya  12 , Brian Olshansky  13 , Roman Piotrowski  10 , Sebastian Stec  14 , Dan Wichterle  15   16
Affiliations

Clinical controversy: methodology and indications of cardioneuroablation for reflex syncope

Michele Brignole et al. Europace. .

Abstract

Observational studies and a recent randomized controlled trial have provided some evidence that cardioneuroablation (CNA) may prevent syncope recurrence in patients affected by cardioinhibitory reflex syncope during the first 2 years following the procedure. Nevertheless, many issues concerning clinical indications, methodology, and long-term results remain unresolved. These issues constitute the background of this manuscript in which pioneers in CNA and experts in syncope debated critical aspects aimed at finding agreement or, if not possible, that highlighting the controversies could be addressed in future studies.

Keywords: Catheter ablation; Methods; Neurally mediated syncope; Reflex syncope; Syncope; Vasovagal syncope.

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Conflict of interest statement

Conflict of interest: The authors have no relevant affiliations or financial involvement withany organization or entity with afinancial interest in or financial conflictwith the subject matter or materials discussed in the manuscript. Thisincludesemployment, consultancies, honoraria, stock ownership oroptions, expert testimony, grants or patents received orpending, orroyalties.

Figures

Graphical Abstract
Graphical Abstract
Observational studies and a recent randomized controlled trial have provided some evidence that cardioneuroablation (CNA) may prevent syncope recurrence in patients affected by cardioinhibitory reflex syncope during the first 2 years following the procedure. Nevertheless, many issues concerning clinical indications, methodology, and long-term results remain unresolved. These issues constitute the background of this manuscript in which pioneers in CNA and experts in syncope debated critical aspects aimed at finding agreement or, if not possible, that highlighting the controversies could be addressed in future studies.
Figure 1
Figure 1
Drawing of the posterior view (A) and superior view (B) of the human heart and major vessels illustrating the location of the posterior atrial ganglionated plexuses. The SPSGP and the IPSGP are depicted. The SPSGP lays paraseptal close to the SVC and to the sinoatrial node (not shown). The IPSGP is in the inferoposterior part of the interatrial septum close to the AV node (not shown). Positions of the pulmonary veins (PV), superior vena cava (SVC), inferior vena cava (IVC), right ventricle (RV), and left ventricle (LV) are shown. Modified from Armour et al., with permission. AV, atrioventricular; IPSGP, inferior paraseptal atrial ganglionated plexus; SPSGP, superior paraseptal ganglionated plexus.
Figure 2
Figure 2
Electroanatomic map of the RA. Typical site of radiofrequency application (red bullets) of the SPSGP and of the IPSGP. An example of fragmented atrial electrograms recorded in the site of the lesion is shown. Modified from Piotrowski et al., with permission. IPSGP, inferior paraseptal ganglionated plexus; RA, right atrium; SPSGP, superior paraseptal ganglionated plexus.
See this image and copyright information in PMC

Comment in

References

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