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Cardioneuroablation: A Comprehensive Review
Journal article   Open access   Peer reviewed

Cardioneuroablation: A Comprehensive Review

Sergio Conti, Andrea Giuseppe Porto, Paolo Zappulla and Giuseppe Sgarito
Reviews in cardiovascular medicine, Vol.27(5), 48106
05/01/2026
DOI: 10.31083/RCM48106
PMCID: PMC13227358
PMID: 42238634
url
https://pmc.ncbi.nlm.nih.gov/articles/PMC13227358/View
Published (Version of record) Open Access

Abstract

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.
 atrioventricular block cardioneuroablation sinus arrest syncope vasovagal syncope

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