Po-03-036 cardioneuroablation for vagally-mediated bradyarrhythmia: a single-center experience

Cardioneuroablation (CNA) is a novel catheter-ablation technique for the treatment of vagally-mediated bradyarrhythmia, which aims to blunt the cardioinhibitory reflex by targeting parasympathetic ganglionated plexi (GPs). Early-phase studies have shown promising results, but clinical evidence remains limited. The aim of our study was to investigate the clinical impact of CNA on our cohort of patients with vaso-vagal syncope (VVS), symptomatic functional atrioventricular block (AVB), and sinus node dysfunction (SND). Baseline and procedural characteristics, procedure-related complications, and clinical outcomes were collected in patients who underwent CNA from December 2018 to October 2022. For GPs localization, our procedural workflow combined 3D-anatomical mapping of both atria with high-amplitude fractionated bipolar electrograms (figure). Statistical analysis was performed using Wilcoxon's -test. A total of 16 patients were included. Patients were young (42±16 years) and without structural heart disease (LVEF 58±4 ml). Ablation indication was mainly VVS (56%), followed by AVB (25%) and SND (19%). Syncope was the most common symptom, with a burden of 10 per person lifetime. Mean procedure time was 94±44 min, with minimal fluoroscopy dose (2.7±1.7 Gy/cm2). RR interval acutely decreased after ablation (1046±290ms vs. 747±133ms, p<0.0001). No major complications occurred, we observed one post-ablation pericarditis and two sinus tachycardia which required medical treatment. At a median follow-up of 523 days (IQR: 1021-228) two patients had recurrences, both cases were syncopal events without documentation at loop-recorder of sinus bradycardia or atrial bradyarrhythmia. Heart rate at last recorded ECG (331 days, IQR: 570-97) was still significantly higher than baseline (60±13 bpm vs. 81±9 bpm, p=0.0001). Patients’ physical health significantly improved after ablation (WHOQOL-BREF score 61.1% vs 75.3%, p=0.03), no significant changes were observed in the other QoL domains (psychological, social relationships, environmental health). CNA reduced the syncope burden and improved the QoL of patients with vagally-mediated bradyarrhythmia. Ablation is reasonably safe in experts’ hands, especially if compared with the long-life risk of device-related complications. Further large-scale randomized studies are needed to support these findings and validate appropriate patient selection criteria.