Cardioneuroablation (CNA) is emerging as an appealing therapeutic option for patients with vasovagal reflex syncope. This review examines key aspects of CNA, including patient selection, procedural aspects and mid-term effects. We critically evaluate procedural results from recent studies and address ongoing challenges, such as the need for standardized procedural protocols and harmonized postprocedural data collection. In addition, we outline current gaps in knowledge concerning long-term pathophysiological effects of the procedure, in particular regarding ventricular arrhythmia susceptibility and exercise capacity.
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First experience with a new tool for automatic mapping of fragmented signals in a case report of cardioneuroablation.
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Clinic for Cardiology and Pneumology, University Medical Center Göttingen, Göttingen, Germany.
Cardioneuroablation is a treatment option for patients with recurrent vasovagal syncope (VVS). Ablation targets of parasympathetic ganglionated plexi (GP) adjacent to the right and left atrial walls and distal endocardial inputs of these GP can be identified both by their anatomical localization and by intracardiac mapping of fragmented electrogram signals. In this case of a successful cardioneuroablation of a 22-year-old patient suffering from recurrent VVS, a new algorithm for automatic mapping of fragmented signals (CARTO Elevate Module, Biosense Webster) was used to identify areas of GP.
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The autonomic regulation of heart rate (HR) reactivity to acute hypoxia remains unclear. Parasympathetic cardioneuroablation (PCNA) may serve as a novel model for the analysis of physiological consequences of reduced vagal influence over sinus node in humans. We studied 11 adult patients scheduled for PCNA for the treatment of vasovagal syncope.
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Vasovagal syncope (VVS) is the most common cause of syncope, and significantly impacts quality of life despite its benign nature. For some patients, conventional management strategies such as lifestyle changes, pharmacotherapy and pacemaker implantation, fail to prevent recurrence. Cardioneuroablation (CNA), a novel intervention targeting the cardiac autonomic nervous system's ganglionated plexi, has shown promise in addressing refractory VVS.
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Cardioneuroablation (CNA) is now recognized as a safe and effective method in patients with cardioinhibitory neurocardiogenic syncope (CNCS), especially in young patients in order to avoid or prolong, as much as possible, the timing of definitive cardiac pacing. Several investigations have shown beneficial and very satisfactory results with a standard non-extensive endocardial ablation, aimed at identifying high-amplitude fragmented signals in the right and left atria. Despite this, the current scientific debate is focused about a proposal on an ablative method, even more individualized than CNA (at least as a first approach), considering that a standardized approach, especially in the left atrium, could expose CNCS patients with a good prognosis to an excessive risk of complications.
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Division of Cardiology, Cardiovascular and Thoracic Department, "Citta della Salute e della Scienza" Hospital.
Cardioneuroablation (CNA) is emerging as an appealing therapeutic option for patients with vasovagal reflex syncope. This review examines key aspects of CNA, including patient selection, procedural aspects and mid-term effects. We critically evaluate procedural results from recent studies and address ongoing challenges, such as the need for standardized procedural protocols and harmonized postprocedural data collection.
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