Background: Cardioneural ablation (CNA) shows promise as a viable alternative to permanent cardiac pacing and pharmacotherapy for patients with symptomatic functional bradycardia and debilitating vasovagal syncope (VVS).
Objective: To report the feasibility, safety, and clinical efficacy of CNA from a large, first-ever multicenter US registry.
Methods: A multicenter registry from 15 US sites was established by collecting data from consecutive patients undergoing CNA for recurrent VVS or symptomatic functional bradycardia [sinus bradycardia (SB) or atrioventricular block (AVB)] refractory to medical therapy and behavioral modification.
Results: 205 patients that underwent 210 CNA procedures were included, mean age was 47±17 years, 49% were female and baseline LVEF was 60±5%. The most common indication for CNA was VVS syncope in 62%, followed by SB in 32%, AVB in 3%, or both SB and AVB in 2%.Endocardial ablation targeting GPs was performed in both atria in 77%, with 697±515 seconds of radiofrequency application of. Vagal and sympathetic responses during ablation were observed in 52% and 73% of cases, respectively. The mean increase in heart rate immediately after ablation was 20±15 bpm. Complications were observed in 4.7% of procedures with a major adverse event rate of 1.4% (2 hemopericardium, 1 death). At a mean follow-up of 14±11 months, 78% of patients with syncope remained free from recurrence, with a reduction in episodes from a median 7 (4−15) to median of 0 episodes. 97% of the cohort remained free from pacemaker implantation.
Conclusion: In the largest multicenter CNA experience to date, acceleration of baseline heart rate and a significant reduction in syncope burden was achieved with an acceptable rate of major procedural complications.
Editor-in-Chief
Kalyanam Shivkumar, MD, PhD, FACC
CME Editor
Kenneth A. Ellenbogen, MD, FACC
Author
Mahmoud Houmsse, MD
Important Dates
Date of Release: August 25, 2025
Term of Approval/Date of CME/MOC Expiration: August 24, 2026