Cardioneuroablation for Ictal Asystole: A Multicenter Case Series
John H Bertot1, Tolga Aksu2, Henry Huang3
1Division of Cardiovascular Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
JACC. Clinical Electrophysiology
|April 23, 2026
Summary
Cardioneuroablation (CNA) offers a safe option for managing ictal asystole, significantly reducing syncope in most epilepsy patients. Repeat procedures or pacemakers may be necessary for persistent symptoms.
Area of Science:
- Cardiology
- Neurology
- Epilepsy Management
Background:
- Cardioneuroablation (CNA) is an emerging therapy for bradyarrhythmias.
- Its effectiveness for ictal asystole, a severe epilepsy complication, is not well-established.
Purpose of the Study:
- To summarize the procedural details and clinical outcomes of CNA in patients experiencing ictal asystole.
- To evaluate the safety and efficacy of CNA for this specific condition.
Main Methods:
- A retrospective, multicenter study involving 12 adult patients with ictal asystole (≥ 4 seconds) from 2017-2025.
- Biatrial CNA utilizing 3D electroanatomic mapping to identify and ablate ganglionated plexi (GPs).
Main Results:
- 10/12 patients showed improved sinus rate post-CNA, with 9/12 exhibiting a blunted atropine response.
- 8/12 patients remained free from ictal asystole after a median follow-up of 20.5 months.
- Four patients required repeat CNA, and two eventually needed pacemaker implantation; no procedural complications were reported.
Conclusions:
- Biatrial CNA is a safe procedure for ictal asystole, potentially reducing syncope burden.
- Long-term efficacy may require repeat ablations or permanent pacing, necessitating further prospective research.
More Related Videos
Related Concept Videos
01:25ECG Interpretation of Arrhythmias II: Atrial, Junctional and Ventricular Arrhythmias
1.1K
Arrhythmia is a condition characterized by an irregular heart rhythm, with ECG changes that differ based on its origin and nature. The types of arrhythmias discussed below include atrial, junctional, and ventricular arrhythmias.Atrial ArrhythmiasPremature Atrial Complexes (PACs): PACs are early atrial beats caused by stress, caffeine, alcohol, electrolyte imbalances, hypoxia, hyperthyroidism, or certain medications (e.g., bronchodilators and decongestants). The ECG shows early P waves with an...
1.1K
01:25Cardiopulmonary Resuscitation IV: Pharmacological Management
1.6K
Pharmacologic intervention is crucial in treating cardiac arrest patients during ACLS or Advanced Cardiovascular Life Support. The ACLS algorithms guide the administration of specific drugs based on the patient's cardiac arrest rhythm, which includes pulseless ventricular tachycardia (VT), ventricular fibrillation (VF), asystole, and pulseless electrical activity (PEA).EpinephrineIndication: Epinephrine is the first-line drug for all cardiac arrest rhythms.Mechanism of Action: Epinephrine...
1.6K
01:23Cardiopulmonary Resuscitation III: AED Use
1.7K
Introduction to AEDAn Automated External Defibrillator (AED) is a portable medical device that analyzes the heart's rhythm and, if necessary, delivers an electrical shock to help the heart re-establish an effective rhythm during sudden cardiac arrest (SCA). SCA occurs when the heart suddenly and unexpectedly stops beating, leading to a loss of blood flow to the brain and other vital organs. In such emergencies, time is of the essence, and using an AED, combined with Cardiopulmonary...
1.7K
01:30Acute Coronary Syndrome III: Diagnostic Studies
493
Diagnosing acute coronary syndrome or ACS begins with a thorough patient history. Notable symptoms include central, crushing chest pain radiating to the left arm, neck, jaw, or back, along with shortness of breath, sweating (diaphoresis), nausea, vomiting, dizziness, and palpitations.It is crucial to note any history of cardiac illnesses and assess risk factors, including age, gender, smoking, hypertension, diabetes, hyperlipidemia, and a sedentary lifestyle.During physical examination, vital...
493