Cardioneuroablation: A Comprehensive Review

Cardioneuroablation (CNA) has emerged as a promising therapeutic strategy for functional bradyarrhythmias, particularly in cases of cardioinhibitory neurocardiogenic syncope and certain forms of atrial fibrillation. Indeed, by targeting vagal innervation through endocardial radiofrequency catheter ablation, CNA can obviate the need for pacemaker (PM) implantation. This technique involves denervation of specific vagal nerve structures within the atria to modulate autonomic balance and prevent symptomatic bradycardia. The efficacy of this approach stems from the recognition that an imbalance between sympathetic and parasympathetic tones, often characterized by excessive vagal activity, underpins these arrhythmogenic conditions. Indeed, CNA may be more effective than a permanent PM implantation in some patients, as this method addresses the underlying etiology rather than merely treating symptoms. Specifically, modulating autonomic nervous system (ANS) signaling through procedures such as CNA holds considerable promise for preventing and treating a range of cardiac arrhythmias. This review aims to synthesize current knowledge regarding various CNA techniques, exploring the associated mechanisms, clinical applications, and outcomes across diverse patient populations.