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Background <p>Neurocardiogenic syncope (NCS), particularly cardioinhibitory and mixed subtypes, remains a clinical challenge when refractory to conventional therapy. Cardioneuroablation (CNA) targeting the parasympathetic ganglionated plexi has emerged as a novel interventional option. This study evaluates the efficacy of biatrial CNA with extracardiac vagal stimulation (ECVS) validation in preventing recurrence and modulating cardiac autonomic regulation.</p> Methods <p>A single-center combined retrospective–prospective cohort study was conducted at a fourth-level institution in Colombia, including patients with cardioinhibitory or mixed-type NCS refractory to conventional treatment. CNA was performed targeting both atria with three-dimensional mapping, followed by ECVS via the internal jugular vein for pre/post validation. Primary outcome was the recurrence of syncope. Secondary outcomes included changes in heart rate variability (HRV) and quality of life (QoL) as assessed by 24-hour Holter monitoring and the SF-36 questionnaire, respectively. Mean follow-up was 24 months. Statistical analysis was performed using SPSS Statistics 28.0.0.0.</p> Results <p>Fifty-three patients (mean age 42.8 ± 10.1 years, 70% cardioinhibitory type) were included. Recurrence occurred in 7 patients (13.2%), with 86.8% syncope-free survival. HRV parameters decreased after CNA (SDNN: 137.03ms vs. 83.18ms; SDANN index: 79.12 vs. 39.35; RMSSD: 38.75ms vs. 13.91ms; <i>p</i> &lt; 0.001), indicating vagal suppression. QoL improved significantly (SF-36 score: 81.91 vs. 94.62, <i>p</i> &lt; 0.001). No major procedural complications or mortality were reported.</p> Conclusion <p>CNA with ECVS validation is effective in reducing syncope recurrence, suppressing excessive parasympathetic tone, and improving QoL in patients with refractory neurocardiogenic syncope. These findings support its use as a therapeutic option in selected patients.</p> Graphical Abstract <p></p>

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Cardioneuroablation in the management of neurocardiogenic syncope with extracranial validation: efficacy and effects on the regulation of the cardiac autonomic system – a combined retrospective–prospective cohort study

  • 期刊论文

  • 发表日期：

    2026年1月8日

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  • Alexander Álvarez Ortiz,
  • Leonor Eugenia Mariño Murillo,
  • Juan Carlos Zerpa,
  • Carlos Thiene Pachón,
  • José Carlos Pachón Mateos,
  • María Alejandra Álvarez Mariño,
  • Jose P. Lopez-Lopez

摘要

Background

Neurocardiogenic syncope (NCS), particularly cardioinhibitory and mixed subtypes, remains a clinical challenge when refractory to conventional therapy. Cardioneuroablation (CNA) targeting the parasympathetic ganglionated plexi has emerged as a novel interventional option. This study evaluates the efficacy of biatrial CNA with extracardiac vagal stimulation (ECVS) validation in preventing recurrence and modulating cardiac autonomic regulation.

Methods

A single-center combined retrospective–prospective cohort study was conducted at a fourth-level institution in Colombia, including patients with cardioinhibitory or mixed-type NCS refractory to conventional treatment. CNA was performed targeting both atria with three-dimensional mapping, followed by ECVS via the internal jugular vein for pre/post validation. Primary outcome was the recurrence of syncope. Secondary outcomes included changes in heart rate variability (HRV) and quality of life (QoL) as assessed by 24-hour Holter monitoring and the SF-36 questionnaire, respectively. Mean follow-up was 24 months. Statistical analysis was performed using SPSS Statistics 28.0.0.0.

Results

Fifty-three patients (mean age 42.8 ± 10.1 years, 70% cardioinhibitory type) were included. Recurrence occurred in 7 patients (13.2%), with 86.8% syncope-free survival. HRV parameters decreased after CNA (SDNN: 137.03ms vs. 83.18ms; SDANN index: 79.12 vs. 39.35; RMSSD: 38.75ms vs. 13.91ms; p < 0.001), indicating vagal suppression. QoL improved significantly (SF-36 score: 81.91 vs. 94.62, p < 0.001). No major procedural complications or mortality were reported.

Conclusion

CNA with ECVS validation is effective in reducing syncope recurrence, suppressing excessive parasympathetic tone, and improving QoL in patients with refractory neurocardiogenic syncope. These findings support its use as a therapeutic option in selected patients.

Graphical Abstract