Cardioneuroablation for vasovagal syncope and atrioventricular block: A step-by-step guide

Area of Science:

• Cardiology
• Electrophysiology
• Autonomic Nervous System

Background:

• Vasovagal syncope and atrioventricular block can result from excessive vagal nerve activity.
• Catheter-based cardioneuroablation is an emerging therapeutic option for these conditions.
• Growing consensus exists regarding patient selection, techniques, and endpoints for cardioneuroablation.

Purpose of the Study:

• To provide a comprehensive, step-by-step pragmatic review of catheter-based cardioneuroablation.
• To elucidate the anatomy of the intrinsic cardiac autonomic nervous system.
• To guide clinicians on indications, management, and limitations of the procedure.

Main Methods:

• Review of current literature and expert consensus on cardioneuroablation.
• Systematic approach covering anatomical basis, procedural steps, and patient care.
• Discussion of necessary equipment and potential procedural limitations.

Main Results:

• Detailed overview of the intrinsic cardiac autonomic nervous system relevant to ablation.
• Established guidelines for patient selection, pre- and post-procedure management.
• Identification of key technical aspects and procedural endpoints.

Conclusions:

• Catheter-based cardioneuroablation is a viable treatment for vagal hyperactivity-related cardiac conditions.
• A standardized, step-by-step approach enhances procedural understanding and application.
• Further understanding of cardiac autonomic anatomy and procedural nuances is crucial for optimal outcomes.