Arrhythmias & electrophysiology
Cardioneuroablation for Ictal Asystole: A Multicenter Case Series
Authors' conclusion
In patients with ictal asystole, biatrial CNA appears to be safe and may substantially reduce syncope burden, although repeated ablation or permanent pacing may be required. Prospective studies are needed to better define efficacy and long-term outcomes.
Study context
- Population
- Adult patients who underwent cardioneuroablation (CNA) for ictal asystole (≥4 s) from 2017 to 2025patients included
- Participants
- 12 patients
- Outcome
- Sinus rate increase ≥25% after CNA
- Follow-up
- After CNA
Methodological details6 international centers
- 6 international centers
Main finding
As reported in the abstract
Patients with sinus rate increased by ≥25%
10 of 12
Observational data: associations, not effects.
Further findings
Blunted atropine response · After CNA
- Patients with blunted atropine response
- 9 of 12
Freedom from ictal asystole · median follow-up of 20.5 months
- Patients free from ictal asystole
- 8 of 12
Recurrent syncope and repeated CNA · 2 to 15 months
- Patients with recurrent syncope who underwent repeated CNA
- Four
- Of those, achieving durable freedom from syncope
- one
Pacemaker implant
- Patients ultimately requiring a pacemaker implant
- Two
Baseline and procedural characteristics
- Age
- 39 ± 9 years
- Female
- 50%
- Focal impaired-awareness seizures
- 9/12
- Mean asystole
- 16 ± 8 s
- Median number of syncopal events
- 7
- Under conscious sedation
- 75%
- Right superior GP ablated
- 12 of 12
- Right inferior GP ablated
- 10 of 12
- Left inferior GP ablated
- 9 of 12
- All patients exhibited sinus arrest during the events
Safety
- No procedural complications occurred
Original publication
Cardioneuroablation for Ictal Asystole: A Multicenter Case Series. JACC Clin Electrophysiol. Published 23 April 2026. doi:10.
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