Cardioneuroablation as a new modality of invasive treatment of functional bradyarrhythmias: initial experience

Introduction: Cardioinhibitory mechanisms are very common and usually benign cause of syncope. A frequent recurrence of syncopal spells significantly reduces the quality of life and may result in serious injuries. Both pharmacological therapy and non-pharmacological measures are often ineffective. Goal: To show our initial experience with an interventional treatment aimed at reducing the parasympathetic tone using radiofrequency catheter ablation (also known as cardioneuroablation, CNA).

Methods and Results: Initial 20 patients (mean age 42 ± 13 years, 10 men, 10 women) were included in the trial. The mean duration of asystolic pauses was 11.4 ± 11 s (4.3 - 40 s). The duration of the CNA procedure was 75 ± 20 min (X-ray time 5.8 ± 4.9 min) and no acute peri - or post-procedural complications were noted. A successful procedure (absence of syncope or bradycardia during the mean follow-up of 424 ± 222 days) was confirmed in 95 % of the patients. In one patient (5 %), however, an AAIR pacemaker had to be eventually implanted.

Conclusion: CNA seems to be an effective and safe method of treatment in patients with cardioinhibitory reflex syncope and parasympathetically induced bradycardias. It can help to avoid permanent pacemaker implantation, especially in younger individuals, and, thus, the devastating complications associated with the life-long presence of a cardiac pacing system.

Keywords: syncope, cardioinhibitory, cardioneuroablation, ganglionated plexi.