Potential proarrhythmic effects of cardioneuroablation: Primum non nocere

Cardioneuroablation (CNA) represents a novel approach to treat patients with vasovagal syncope (VVS), with a goal of (partial) vagal denervation. This procedure involves ablation of the ganglionated plexi (GP) located in the epicardial fat around the right and left atrium and, thus, it aims to eliminate the vagal input to the heart ( 1 Pachon JC, Pachon EI, Aksu T et al. Cardioneuroablation: Where are we at? Heart Rhythm O2 2023;4:401-413 https://doi.org/10.1016/j.hroo.2023.02.007 Google Scholar ). Many nonrandomized studies suggest significant improvement in syncope recurrences with CNA while, only recently, the first small randomized trial was published and confirmed the efficacy of CNA ( 2 Piotrowski R. Baran J. Sikorska A. Krynski T. Kulakowski P. Cardioneuroablation for Reflex Syncope. JACC: Clinical Electrophysiology. 2023; 9: 85-95https://doi.org/10.1016/j.jacep.2022.08.011 Crossref PubMed Scopus (19) Google Scholar ). However, roughly 20 years after its first description, multiple issues including optimal methods to identify GP, procedural efficacy readouts, assessment methods of vagal input to the heart, and the order and extent of GP ablation remain unclear. Importantly, the long-term effects of CNA on cardiac and autonomic function are yet to be determined. Ischemia-induced ventricular proarrhythmia and cardiovascular autonomic dysreflexia after cardioneuroablationHeart RhythmPreviewCardioneuroablation (CNA) is an attractive treatment of vasovagal syncope. Its long-term efficacy and safety remain unknown. Full-Text PDF