Page 26 - BH-3-1

Brain & Heart

REVIEW ARTICLE
Cardioneuroablation for vagally mediated

bradyarrhythmia: A case study with a systematic
review

1
1
1
Feng Hu 1† , Yali Wang , Minhua Zang , Bin Xu , Guangyu Li , Guangyu Wang ,
2†
1
3
3
Zhiqing Qiao 1 , Lihui Zheng , Yan Yao * , and Jun Pu *
1
1 Department of Cardiology, Renji Hospital, School of Medicine, Shanghai Jiaotong University,
Shanghai, China
2 Department of Respiratory Medicine, Renji Hospital, School of Medicine, Shanghai Jiaotong
University, Shanghai, China
3 Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese
Academy of Medical Sciences and Peking Union Medical College, Beijing, China
(This article belongs to the Special Issue: The Brain Disorders with Left Atrium)
Abstract

This study evaluates the efficacy of cardioneuroablation (CNA) for vagally mediated
† These authors contributed equally bradyarrhythmia (VMB) through two case reports, a systematic review and a meta-
to this work. analysis. Two patients with VMB were treated with CNA targeting ganglionated plexi
*Corresponding authors: using a radiofrequency ablation catheter. Both patients showed sustained clinical
Jun Pu improvement post-CNA, with no recurrence of syncope or pre-syncope during
(pujun310@hotmail.com)
Yan Yao follow-up periods of 26 and 16 months. We performed a meta-analysis, according to
(ianyao@263.net.cn) the preferred reporting items for systematic reviews and meta-analyses guidelines
Citation: Hu F, Wang Y, Zang M, to review 19 studies involving 618 patients, excluding animal studies, case reports,
et al. Cardioneuroablation for and studies limited to immediate responses. The analysis revealed that 94.3%
vagally mediated bradyarrhythmia: (95% confidence interval [CI]: 90.9 – 97.7%) of patients were symptom-free during
A case study with systematic follow-up, while only 4.5% (95% CI: 2.6 – 6.4%) required pacemaker implantation.
review. Brain & Heart.
2025;3(1):4824. Procedure-related complications were reported in 4.7% (95% CI: 2.3 – 7.1%) of overall
doi: 10.36922/bh.4824 cases. These findings suggest that CNA is an effective and safe treatment option
Submitted: September 11, 2024 for VMB, reducing symptom recurrence and the need for pacemaker implantation.
Further randomized controlled trials are warranted to validate its long-term efficacy.
Revised: November 4, 2024
Accepted: November 18, 2024
Keywords: Cardioneuroablation; Vagally mediated bradyarrhythmia; Radiofrequency
Published online: December 12, ablation; Ganglionated plexus
2024
Copyright: © 2024 Author(s).
This is an Open-Access article
distributed under the terms of the
Creative Commons Attribution 1. Introduction
License, permitting distribution,
and reproduction in any medium, The autonomic nervous system, comprising the sympathetic and parasympathetic
provided the original work is branches, directly regulates the heart rate and rhythm. In many cases of bradyarrhythmia,
properly cited. an imbalance in autonomic tone is observed, which is typically characterized by excessive
1,2
Publisher’s Note: AccScience parasympathetic activity and reduced sympathetic influence. This imbalance can lead
Publishing remains neutral with to a slower heart rate than usual, known as vagally mediated bradyarrhythmia (VMB),
regard to jurisdictional claims in
published maps and institutional which may potentially result in symptoms such as fatigue, dizziness, and syncope.
affiliations. Intermittent sinus bradycardia, sinus node dysfunction, and atrioventricular block are

Volume 3 Issue 1 (2025) 1 doi: 10.36922/bh.4824