Cardioneuroablation using an anatomical approach: a new and promising method for the treatment of cardioinhibitory neurocardiogenic syncope

Neurally mediated syncope (NMS) is the most common cause of syncope and is brought about by enhanced vagal tone leading to asystole, sinus bradycardia, or atrioventricular block (AVB) [1]. According to the current guidelines, dual-chamber cardiac pacing may be considered in patients > 40 years old, when the correlation between syncopal episodes and asystole is documented. In younger patients, pacemaker implantation may be considered only in very selected cases [1]. Recently, endocardial biatrial ablation of ganglionated plexi (GP) has been shown to provide excellent shortand long-term results in the treatment of syncope caused by cardioinhibitory reflex syncope or functional AVB [2–4]. However, this method, called cardioneuroablation (CNA), is still evolving, and more data are needed to establish its role in the treatment of NMS. We present three patients with frequent syncopal episodes due to cardioinhibitory mechanism, who underwent CNA in order to improve symptoms and avoid pacemaker implantation.