Cardioneuroablation for vagally mediated bradyarrhythmia: A case study with a systematic review

Abstract

This study evaluates the efficacy of cardioneuroablation (CNA) for vagally mediated bradyarrhythmia (VMB) through two case reports, a systematic review and a metaanalysis. Two patients with VMB were treated with CNA targeting ganglionated plexi using a radiofrequency ablation catheter. Both patients showed sustained clinical improvement post-CNA, with no recurrence of syncope or pre-syncope during follow-up periods of 26 and 16 months. We performed a meta-analysis, according to the preferred reporting items for systematic reviews and meta-analyses guidelines to review 19 studies involving 618 patients, excluding animal studies, case reports, and studies limited to immediate responses. The analysis revealed that 94.3% (95% confidence interval [CI]: 90.9 - 97.7%) of patients were symptom-free during follow-up, while only 4.5% (95% CI: 2.6 - 6.4%) required pacemaker implantation. Procedure-related complications were reported in 4.7% (95% CI: 2.3 - 7.1%) of overall cases. These findings suggest that CNA is an effective and safe treatment option for VMB, reducing symptom recurrence and the need for pacemaker implantation. Further randomized controlled trials are warranted to validate its long-term efficacy.

Keywords

Cardioneuroablation / Vagally mediated bradyarrhythmia / Radiofrequency ablation / Ganglionated plexus

Acknowledgments

None.

Funding

This work was supported by the Shanghai Municipal Key Clinical Specialty (shslczdzk06204), the Shanghai Professional Technical Service Platform for Biological Sample and Database of Cardiovascular and Cerebrovascular Diseases (22DZ2292400), the Shanghai Clinical Research Center for Aging and Medicine (19MC1910500), and the Shanghai Municipal Health Commission Top Priority Research (2023ZZ02021).

Conflict of interest

Yan Yao is an Editor-in-Chief of this journal and Guest Editor of this special issue but was not in any way involved in the editorial and peer-review process conducted for this paper, directly or indirectly. Separately, other authors declared that they have no known competing financial interests or personal relationships that could have influenced the work reported in this paper.

Author contributions

Conceptualization: Yan Yao, Jun Pu

Investigation: Minhua Zang, Bin Xu

Methodology: Guangyu Li, Guangyu Wang, Zhiqing Liao, Lihui Zheng

Writing-original draft: Feng Hu, Yali Wang

Writing-review & editing: Yan Yao, Jun Pu

Ethics approval and consent to participate

A written informed consent was obtained from all patients in this study.

Consent for publication

A written informed consent was obtained from each of the subjects to publish their data and images.

Availability of data

The data used in this article will be shared upon reasonable request to the corresponding author.

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