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

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,  = 0.001), a shortening of the PQ interval (-18 ± 18 msec,  < 0.001), a reduction of the correct sinus node recovery times (cSNRT) (-142 ± 204 msec,  = 0.114), a shortening of the AH interval (-31 ± 26 msec,  = 0.008), a reduction of the effective refractory period of the atrio-ventricular node (-156; interquartile range from -30 to -160 msec,  = 0.042) and an increase in the Wencheback point (27 ± 20 bpm,  < 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.