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. 2025 Jan 13:11:1526825.
doi: 10.3389/fcvm.2024.1526825. eCollection 2024.

Cardioneuroablation for reflex syncope or functional bradyarrhytmias: new insight from a single center experience

Noemi Valenti #  1 , Antonio Di Monaco #  1 , Imma Romanazzi  2 , Nicola Vitulano  1 , Federica Troisi  1 , Federico Quadrini  1 , Antonio Vitullo  3 , Luca Sgarra  1 , Rosa Caruso  1 , Vincenzo Anzelmo  1 , Pietro Guida  1 , Natale Daniele Brunetti  3 , Massimo Grimaldi  1
Affiliations

Cardioneuroablation for reflex syncope or functional bradyarrhytmias: new insight from a single center experience

Noemi Valenti et al. Front Cardiovasc Med. .

Abstract

Background: Cardioneuroablation (CNA) is a new approach to treat reflex syncope and functional bradyarrhytmias caused by autonomic imbalance. We report our experience using CNA.

Method: From September 2022 to July 2023, we took care of 21 patients (mean age 42 ± 21 years; 62% male) affected by reflex syncope or functional bradyarrhythmias. All patients underwent CNA under conscious sedation targeting the superior and/or inferior paraseptal ganglionated plexus (GPs).

Results: Nine patients were affected by vasovagal syncope (VVS) and twelve by functional bradyarrhythmias. In 3 cases (14%) the ablation was performed only on the GPs of the right atrium, while in the remaining 86% of cases we performed biatrial lesions. As regards the acute results, we highlighted an increase in sinus heart rate (12 ± 15 bpm, p = 0.001), a shortening of the PQ interval (-18 ± 18 msec, p < 0.001), a reduction of the correct sinus node recovery times (cSNRT) (-142 ± 204 msec, p = 0.114), a shortening of the AH interval (-31 ± 26 msec, p = 0.008), a reduction of the effective refractory period of the atrio-ventricular node (-156; interquartile range from -30 to -160 msec, p = 0.042) and an increase in the Wencheback point (27 ± 20 bpm, p < 0.001). At follow-up, a single patient, due to persistent symptoms and bradyarrhythmic disorder, underwent permanent pacemaker implantation; no other patient had recurrence of syncope, and all remained persistently asymptomatic.

Conclusion: Our results confirm the efficacy and safety of CNA for the treatment of VVS and functional bradyarrhythmias, although further studies are needed to support these findings.

Keywords: atrio-ventricular block; bradycardia; cardioneuroablation; catheter ablation; neuromodulation; reflex 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
Electroanatomical mapping of the right and left atrium using the CARTO-3 system (biosense webster) in a patient suffering from cardioinhibitory VVS (VASIS 2B), undergoing biatrial. CNA. Panel (A) Postero-anterior view of the right atrium - Voltage map. The red dots represent the ablation points in the area of the SPSGP (top) and the IPSGP (bottom). The light blue dots represent the course of the phrenic nerve, highlighted by pacing. Panel (B) Left anterior oblique view - Voltage map of the right atrium and Anatomical map of the left atrium. The ablation points in the LSGP area are added to the points in (A) The blue dots represent areas where high frequency stimulation resulted in a vagal response. The yellow dots represent the location of the His bundle. CS, coronary sinus; IVC, inferior vena cava; LA, left atrium; LIPV, left inferior pulmonary vein; LSPV, left superior pulmonary vein; MV, mitral valve; RA, right atrium; SVC, superior vena cava; TV, tricuspid valve.
Figure 2
Figure 2
Electroanatomical mapping of the right and left atrium using the CARTO-3 system (biosense webster) in a patient T suffering from functional AV block, undergoing biatrial CNA. Panel (A) Antero-posterior view of the atria - Anatomical map. Panel (B) Postero-anterior projection - Anatomical map of the atria. The red and the pink dots represent the ablation points with different ablation index, in the area of the IPSGP (from the right and the left side). The yellow dots represent the location of the His bundle. CS, coronary sinus; IVC, inferior vena cava; LA, left atrium; MV, mitral valve; RA, right atrium; SVC, superior vena cava; TV, tricuspid valve.
Figure 3
Figure 3
Mean values with standard deviation of acute results, derived from the comparison between parameters assessed before and immediately after the procedure. AH, AH interval; CNA, cardioneuroablation; cSNRT, correct sinus node recovery times; ERP, effective refractory period; PQ, PQ interval; PRE,; PW, point of Wenckebach; QTc, correct QT interval.
Figure 4
Figure 4
Mean values with standard deviation of results at follow-up, derived from the comparison between parameters assessed before the procedure and at the 12-month follow-up. CNA, cardioneuroablation; LH/HF, ratio between low frequency and high frequency, parameter of frequency domain at Heart Rate Variability; pNN50, percentage of differences between consecutive RR intervals >50 msec, parameter of time domain at Heart Rate Variability; PQ, PQ interval; QTc, correct QT interval; RMSSD, root mean square of the differences between successive normal heart beats, parameter of time domain at Heart Rate Variability; SDNN, standard deviation of all intervals from normal to normal, parameter of time domain at Heart Rate Variability.
Figure 5
Figure 5
Mean values with standard deviation of comparison between immediately post-procedure results and 12-month follow-up results. CNA, cardioneuroablation; PQ, PQ interval; QTc, correct QT interval.
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