Cardioneuroablation for vasovagal syncope: A systematic review and meta-analysis

Registro español de ablación con catéter. XXI informe oficial de la Asociación del Ritmo Cardiaco de la Sociedad Española de Cardiología (2021)

“…Un total de 10 centros han comunicado su experiencia inicial, tanto para la indicación de sincope cardioinhibidor como para la disfunción sinusal funcional. A la espera de estudios con una metodología robusta, los datos disponibles en la actualidad son prometedores 23 .…”

Changes in autonomic response during cardioneuroablation in an elderly patient with carotid sinus syndrome

“…On the other hand, despite the fact that the most common etiology of unexplained syncope in elderly patients is a reflex mechanism, there is no evidence of the use of this technique in this population 6 . During the last decade, some studies have reported encouraging long term results in the reduction of syncope burden in VVS and functional sinus node dysfunction with syncope-free survival rates greater than 90% at one year 7,8 . However, most of these studies only included young patients, with the vast majority of the patients included younger than 50 years old.…”

“…However, in this study, at six months, only 80% of the patients were free of syncope and the only methods to assess denervation were the shortening of the PP intervals and atropine test. Furthermore, a recent meta-analysis involving 465 patients reported that CNA limited to right atrial ablation was associated with a significant lower freedom from syncope (81.5%, 95% CI 51.9%-94.7%, p<0.0001) when compared to left atrial GP ablation (94.0%, 95% CI 88.6%-96.9%) and bi-atrial ablation (92.7%, 95% CI 86.8%-96.1%) 8 . In our experience and according to other authors, a bi-atrial approach is usually needed, especially when targeting the right superior and the left posteromedial GPs.…”

Vasovagal syncope with isolated atrioventricular block following cardioneuroablation demonstrating distinct innervation of the sinus and atrioventricular nodes

“…While observational research has demonstrated that CNA in young patients with VVS can reduce the burden of syncope with the goal of avoiding permanent pacemaker implantation 11 , its practical techniques are still evolving. Our case demonstrates the selective impact of excessive vagal tone on the sinus and AV node during a cardioinhibitory response leading to both sinus arrest and AV block.…”

“…12 However, successful PMGP ablation can require left atrial ablation. 11 Additionally, during radiofrequency application near the PMGP transient AV block and PR prolongation was observed, highlighting the risk of ablating in this area; it can be difficult to tell if the transient AV block is due to parasympathetic GP stimulation, coronary artery spasm, or AV node damage putting the patient at risk of requiring a permanent pacemaker.…”