The aim of our prospective non-randomized study was to evaluate the efficacy and safety of Cardioneuroablation (CNA) in patients with recurrent cardioinhibitory vaso-vagal syncope (VVS) or functional bradyarrhythmias.
From September 2022 to June 2023, a total of 10 ablation procedures were performed on 10 patients who met the inclusion criteria (30% female, mean age 51.9 years, range 19-81 years). In 5 cases the CNA was guided by HFS with documentation of vagal response, while in the other 5 cases it was performed with an anatomical approach. In 3 cases the ablation was performed only on the GPs of the right atrium, while in the remaining 70% of cases biatrial lesions were performed.
As regards the acute endpoints, we observed an increase in sinus heart, a shortening of the PQ interval, a reduction in TRNSc, a shortening of the AH interval and an increase in PW. During follow-up, a single patient, due to persistence of symptoms and bradyarrhythmic disorder, underwent definitive pacemaker implantation. No other patient had a recurrence of syncope and all reported being persistently asymptomatic. As regards the secondary endpoints, we highlighted a persistence of the increase in the minimum and average heart rate, a shortening of the PQ interval, a reduction in time and frequency domain parameters in the HRV analysis on the Holter ECG performed at follow-up. An increasing trend was also highlighted for maximum heart rate, although not significant. There were no significant changes in the QTc interval and no patient developed arrhythmic episodes.
Discussion. Cardioneuroablation is a relatively recent and still developing technique that aims to promote persistent cardiac vagal denervation through endocardial ablation of parasympathetic ganglia. In our prospective study of patients without structural heart disease suffering from recurrent cardioinhibitory VVS or symptomatic functional bradyarrhythmias, CNA was effective in reducing the syncopal burden and other symptoms complained of by patients before the procedure, and safety (only one case of pericardial effusion that did not require any therapy; low rate of exposure to ionizing radiation; not any increase in arrhythmic risk related to a prevalent sympathetic activity; no patient reported discomfort in feeling an average higher heart rate), with a notable improvement in the quality of life.
