Related Experiment Video
Updated: Jun 28, 2026
Quantitative Autonomic Testing
Published on: July 19, 2011
Physiological Markers of Effective Autonomic Denervation Are Associated With Outcomes After Cardioneuroablation for
Jetmir Vojnika1, Darshak Patel1, Andres Enriquiez1
1Department of Medicine, Cardiac Electrophysiology Section, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Insights
Cardioneuroablation (CNA) for vasovagal syncope has a substantial recurrence rate. Achieving specific vagal responses during the procedure is linked to better long-term outcomes and reduced syncope.
Area of Science:
- Cardiology
- Electrophysiology
- Neurology
Background:
- Recurrent vasovagal syncope (VVS) significantly impacts quality of life.
- Cardioneuroablation (CNA) is an emerging treatment for refractory VVS.
- Optimal CNA procedural techniques and success markers require further elucidation.
Purpose of the Study:
- To identify procedural indicators associated with sustained freedom from syncope after CNA.
- To analyze clinical and procedural factors influencing syncope recurrence post-CNA.
Main Methods:
- Retrospective analysis of patients with VVS undergoing CNA.
- Inclusion criteria: refractory VVS, lifestyle modification failure, and ≥1 year follow-up.
- Statistical analysis of clinical and procedural characteristics against syncope recurrence.
Main Results:
- 44% of 57 patients experienced syncope recurrence during 2.2 years of follow-up.
- Favorable markers for syncope-free patients: vagal response during left-sided ganglionated plexus ablation (56% vs 12%), greater sinus rate increase (29.9 vs 10.0 bpm), and less frequent positive atropine response (3% vs 24%).
- Patients achieving all 3 markers had the lowest recurrence rate (14%).
Conclusions:
- A significant proportion of patients experience syncope recurrence after CNA.
- Suboptimal acute procedural endpoints may correlate with increased syncope recurrence.
- Identifying and achieving specific physiological markers during CNA may improve long-term efficacy.
Background:
Cardioneuroablation (CNA) has been increasingly pursued as a treatment for patients with recurrent vasovagal syncope. The optimal procedural approach and acute endpoints are unclear.
Objective:
The goal of this study was to characterize procedural markers linked to durable freedom from syncope.
Methods:
All patients who underwent CNA for vasovagal syncope refractory to lifestyle modification with at least 1 year of follow-up were included in a retrospective cohort. Clinical and procedural characteristics were analyzed for association with recurrence of syncope.
Results:
A total of 57 patients (mean age 39.8 ± 10.7 years; 53% female; 6.7 ± 3.8 episodes of syncope in the prior year) met inclusion criteria. During 2.2 ± 0.8 years of follow-up, 25 patients (44%) had recurrent syncope. Symptomatic inappropriate sinus tachycardia occurred in 14% and was more common after CNA guided by extracardiac vagal stimulation (64% vs 2%). Patients who remained free from recurrent syncope were more likely to exhibit a vagal response during ablation of the left-sided ganglionated plexus (56% vs 12%; P = 0.001), had a greater increase in sinus rate during the ablation (29.9 ± 15.1 beats/min vs 10.0 ± 15.8 beats/min; P = 0.01), and were less likely to exhibit a positive atropine response at the end of the procedure (3% vs 24%; P = 0.04). Patients who exhibited a greater number of these favorable physiological markers had progressively lower rates of recurrent syncope. Patients meeting all 3 criteria had the lowest recurrence rate (14%).
Conclusions:
There is a substantial rate of recurrent syncope after CNA with intermediate-term follow-up. Inadequate acute procedural endpoints may be associated with recurrence.
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