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PO-04-045 CARDIONEUROABLATION FOR ICTAL ASYSTOLE – MULTICENTER CASE SERIES
Abstract   Peer reviewed

PO-04-045 CARDIONEUROABLATION FOR ICTAL ASYSTOLE – MULTICENTER CASE SERIES

John Bertot, Tolga Aksu, Henry D. Huang, Victor Neira Vidal, Matthew Hanson, Timothy Markman, Matthew C. Hyman, Dan Wichterle, Bor Antolič, Mauricio I Scanavacca, …
Heart rhythm, Vol.23(4 Supplement), pp.S653-S653
04/2026
DOI: 10.1016/j.hrthm.2026.03.1064

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Abstract

Background Cardioneuroablation (CNA) is an emerging therapy for vagally-mediated bradyarrhythmias. Its role in ictal asystole, a rare but severe manifestation of epilepsy, remains poorly defined. Objective We aimed to collect and summarize the procedural data and clinical outcomes of patients who underwent CNA for ictal asystole. Methods In a retrospective study, we identified 6 international centers where at least one CNA for ictal asystole (≥ 6 s) in adult patients was performed between 2017 and 2025. Results Twelve patients (ages 39±9 years; 50% female) were included; 67% had focal complex partial epilepsy, and 11/12 had failed ≥1 antiepileptic drug. All patients exhibited sinus arrest during the events, with a mean asystole of 16±8 s. They experienced a median number of 7 syncopal events before CNA. None of them had conduction system disease. Biatrial CNA (75% under general anesthesia) was facilitated by 3D electroanatomic mapping. Ganglionated plexi (GP) were identified using anatomical landmarks and fractionated electrograms, with or without high-frequency stimulation. Right superior (12/12), right inferior (10/12), and left inferior (9/12) GPs were most frequently ablated. After CNA sinus rate increased by ≥25% in 10/12 patients, and 9/12 demonstrated a blunted atropine response. No procedural complications occurred. Over a median follow-up of 24 months, 8/12 patients (67%) remained free of syncope. Four patients experienced recurrent syncope at 2, 9, 12, and 15 months and underwent repeat CNA, with one of them achieving durable freedom from syncope. Two patients ultimately required a pacemaker implant. Conclusion In patients with ictal asystole, biatrial CNA appears safe and offers a meaningful reduction in syncope burden, though some require repeat procedures or eventual permanent pacing. Larger prospective studies are needed to confirm the efficacy of CNA in this population.

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