Arrhythmias & electrophysiology
Cardioneural Ablation for Functional Bradycardia and Vasovagal Syncope: Outcomes From the U.S. Multicenter Cardioneural Ablation (CNA) Registry
Authors' conclusion
In the largest multicenter CNA experience to date, acceleration of baseline heart rate and a significant reduction in syncope burden were achieved with an acceptable rate of major procedural complications. These observational data pave the way for future randomized trials to evolve CNA indications beyond compassionate usage for managing functional bradycardia and reflex syncope.
Study context
- Population
- Patients undergoing CNA for recurrent VVS or symptomatic functional bradycardia (sinus bradycardia [SB] or atrioventricular block [AVB]) refractory to medical therapy and behavioral modification (2018–2024)patients who underwent 210 CNA procedures
- Participants
- 205 patients
- Outcome
- Baseline characteristics
Methodological details15 US sites, consecutive patients
- 15 US sites
- Consecutive patients
Main finding
As reported in the abstract
Mean age
47 ± 17 years
Female
49%
Baseline left ventricular ejection fraction
60% ± 5%
Observational data: associations, not effects.
Further findings
Indication for CNA
- Syncope
- 66.3%
- VVS
- 61.5%
- Syncope related to AVB
- 4.9%
- SB
- 31.2%
- AVB
- 1.5%
- Both SB and AVB
- 0.9%
Procedural characteristics
- Anatomical approach to target typical ganglionated plexus locations
- all cases
- High-frequency stimulation
- 47% of procedures
- Endocardial ablation targeting ganglionated plexuses in both atria
- 77%
- Radiofrequency application
- 697 ± 515 seconds
- Vagal responses during ablation
- 52%
- Sympathetic responses during ablation
- 73%
Increase in heart rate · immediately after ablation
- Mean increase in heart rate
- 20 ± 15 beats/min
Freedom from syncope recurrence (patients with syncope) · mean follow-up of 14 ± 11 months
- Patients with syncope free from recurrence
- 78%
- Syncope episodes before, median
- 7 (4-15)
- Syncope episodes after, median
- 0 (0-0)
Freedom from pacemaker implantation · mean follow-up of 14 ± 11 months
- Cohort free from pacemaker implantation
- 97%
Safety
Procedural complications
- Complications (of procedures)
- 4.7%
- Respiratory failures requiring bilevel positive airway pressure
- 2
- Right diaphragmatic paralysis
- 1
- Sinus node dysfunction
- 4
- Major adverse event rate
- 1.4%
- Hemopericardium
- 2
- Death
- 1
Original publication
Summarised from the published abstract; every number is checked against it