Clinical controversy: methodology and indications of cardioneuroablation for reflex syncope

Brignole, Michele; Aksu, Tolga; Calò, Leonardo; Fanciulli, Alessandra; Deharo, Jean Claude; Fanciulli, Alessandra; Fedorowski, Artur; Kułakowski, Piotr; Morillo, Carlos A.; Moya, Àngel; Olshansky, Brian; Piotrowski, Roman; Stec, Sebastian; Wichterle, Dan

doi:10.1093/europace/euad033

Cited by 32 publications

(21 citation statements)

References 53 publications

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“…The majority of existing literature on CNA primarily focuses on young patients, 19 , 20 even if recent limited evidence suggests that CNA may be a viable therapeutic option for older patients. 12 In the present survey, 30% of responders did not consider age as an exclusion criterion for CNA whereas a quarter of the responders consider CNA only suitable for patients under 40 years old.…”

Section: Discussionmentioning

confidence: 99%

Cardioneuroablation for vasovagal syncope: insights on patients’ selection, centre settings, procedural workflow and endpoints—results from an European Heart Rhythm Association survey

Penela,

Berruezo,

Roten

et al. 2024

Europace

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Aims Cardioneuroablation (CNA) is a catheter-based intervention for recurrent vasovagal syncope (VVS) that consists in the modulation of the parasympathetic cardiac autonomic nervous system. This survey aims to provide a comprehensive overview of current CNA utilization in Europe. Methods and results A total of 202 participants from 40 different countries replied to the survey. Half of the respondents have performed a CNA during the last 12 months, reflecting that it is considered a treatment option of a subset of patients. Seventy-one per cent of respondents adopt an approach targeting ganglionated plexuses (GPs) systematically in both the right atrium (RA) and left atrium (LA). The second most common strategy (16%) involves LA GP ablation only after no response following RA ablation. The procedural endpoint is frequently an increase in heart rate. Ganglionated plexus localization predominantly relies on an anatomical approach (90%) and electrogram analysis (59%). Less utilized methods include pre-procedural imaging (20%), high-frequency stimulation (17%), and spectral analysis (10%). Post-CNA, anticoagulation or antiplatelet therapy is prescribed, with only 11% of the respondents discharging patients without such medication. Cardioneuroablation is perceived as effective (80% of respondents) and safe (71% estimated <1% rate of procedure-related complications). Half view CNA emerging as a first-line therapy in the near future. Conclusion This survey offers a snapshot of the current implementation of CNA in Europe. The results show high expectations for the future of CNA, but important heterogeneity exists regarding indications, procedural workflow, and endpoints of CNA. Ongoing efforts are essential to standardize procedural protocols and peri-procedural patient management.

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Section: Discussionmentioning

confidence: 99%

Cardioneuroablation for vasovagal syncope: insights on patients’ selection, centre settings, procedural workflow and endpoints—results from an European Heart Rhythm Association survey

Penela,

Berruezo,

Roten

et al. 2024

Europace

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“…A recent review by Brignole et al 12 emphasized that the main target for CNA is the superior paraseptal ganglionated plexus (located at the junction between the interatrial septum and the superior vena cava), which is the final common pathway of the right vagus innervating the sinoatrial node. The inferior paraseptal ganglionated plexus (located near the proximal coronary sinus ostium and the posteroseptal junction between the right atrium and inferior vena cava adjacent to posteroinferior left atrium at the so-called pyramid space) is the final common pathway of the left vagus innervating the AV node.…”

Section: Discussionmentioning

confidence: 99%

“…It is unclear whether this can be accomplished by right atrial ablation only or will require left atrial or biatrial ablation. 12 …”

Section: Discussionmentioning

confidence: 99%

Cryoballoon cardioneuroablation: New electrophysiological insights

Herweg,

Patel,

Noujaim

et al. 2024

Heart Rhythm O2

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“…Parasympathetic activation related to the cardiac autonomic nervous system is a highly complex system and has a strong association with atrial fibrillation, ventricular arrhythmias, and as a protective mechanism in the setting of heart failure or postmyocardial ischemia. [29][30][31] Due to limited longterm follow-up for patients post-CNA, the potential risk of future arrhythmia and heart failure should be discussed during the initial counseling.…”

Section: Discussionmentioning

confidence: 99%

Cardioneuroablation for pediatric patients with functional sinus node dysfunction and paroxysmal atrioventricular block

Choi,

Hong,

Moak

2023

Cardiovasc electrophysiol

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IntroductionSevere transitory episodes of bradycardia with subsequent syncope in children are common, and generally portend a benign prognosis. Rarely, patients may experience prolonged asystolic episodes secondary to significant sinus pauses (SP) or paroxysmal atrioventricular block (AVB). Cardioneuroablation (CNA) is a catheter‐based intervention, used to identify and ablate the epicardial ganglionated plexi (GP), which results in disruption of the vagal‐mediated parasympathetic input to the sinus and atrioventricular node.ObjectiveDescribe the methodology and role of CNA for treatment of pediatric patients with functional AVB or SP.MethodsThis is a single‐center, case series study. Patients with SP or AVB, 21 years of age or younger, who underwent CNA between 2015 and 2021 were included. CNA was performed via anatomically guided and high‐frequency stimulation methods.ResultsSix patients were included. The median age was 18.9 years (range 12.3–20.9 years), 33% female. Two patients had prolonged SP, two had paroxysmal AVB, and two had both SP and AVB. Four patients had prior syncope. The median longest pause was 8.9 s (range 3.9–16.8) with 11 total documented pauses (range 2–231) during the 6 months pre‐CNA. Post‐CNA, the median longest pause was 1.3 s (range 0.8–2.2) with one documented SP after termination of atrial tachycardia at the 3‐month follow‐up. At 6 months, the median longest pause was 1.1 s (0.8–1.3) with 0 documented pauses. No patients had syncope post‐CNA.ConclusionCNA may be an effective alternative to pacemaker implantation in pediatric patients with syncope or significant symptoms secondary to functional SP or AVB.

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Clinical controversy: methodology and indications of cardioneuroablation for reflex syncope

Cited by 32 publications

References 53 publications

Cardioneuroablation for vasovagal syncope: insights on patients’ selection, centre settings, procedural workflow and endpoints—results from an European Heart Rhythm Association survey

Cardioneuroablation for vasovagal syncope: insights on patients’ selection, centre settings, procedural workflow and endpoints—results from an European Heart Rhythm Association survey

Cryoballoon cardioneuroablation: New electrophysiological insights

Cardioneuroablation for pediatric patients with functional sinus node dysfunction and paroxysmal atrioventricular block

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