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Review
. 2024 Jul 26:11:1412195.
doi: 10.3389/fcvm.2024.1412195. eCollection 2024.

Cardioneuroablation: the known and the unknown

A Marrese #  1 , R Persico #  1 , E Parlato  1 , D Faccenda  1 , A Salucci  1 , G Comparone  1 , V Pergola  1 , G Ammirati  1 , L Addeo  1 , C Fonderico  1 , L Cocchiara  1 , A Volpe  1 , P Visconti  1 , A Rapacciuolo  1 , T Strisciuglio  1
Affiliations
Review

Cardioneuroablation: the known and the unknown

A Marrese et al. Front Cardiovasc Med. .

Abstract

Cardioneuroablation (CNA) is a novel interventional procedure for the treatment of recurrent vasovagal syncope (VVS) and advanced atrioventricular block secondary to hyperactivation of vagal tone in young patients. By damaging the cardiac parasympathetic ganglia, CNA seems to be able to mitigate and/or abolish the excessive vagal activity and improve patients' outcome. This review is intended to give a detailed and comprehensive overview of the current evidences regarding (1) the clinical applications of CNA (2) the identification of ablation targets and procedural endpoints (3) the medium-long term effect of the procedure and its future perspectives. However, clinical data are still limited, and expert consensus or recommendations in the guidelines regarding this technique are still lacking.

Keywords: atrioventricular block; cardioinhibitory syncope; cardioneuroablation (CNA); fractionated electrograms; high-frequency stimulation (HFS); vasovagal syncope.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Increasing number of publications per year regarding CNA.
Figure 2
Figure 2
Localization of right and left ganglia. Courtesy of Aksu et al. (doi: 10.15420/aer.2022.37).
Figure 3
Figure 3
Mapping of endocardial potentials to find ganglia through the fast Fourier transformation. (A) Compact myocardium has a poor innervation, and the electrical conduction is homogeneous and paracellular due to the presence of connexins. That result in a clear and delineated endocardial potential. (B) Fibrillar myocardium: at the level of the neuro-myocardial interface, as in correspondence of the cardiac ganglia, the neural fibers determine a spectrum of highly fragmented endocardial potentials. Courtesy by Pachon et al. (32).
See this image and copyright information in PMC

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