Cardioneuroablation

Cardioneuroablation

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Cardioneuroablation procedure illustration

Cardioneuroablation (CNA) is a medical procedure aimed at treating certain types of cardiac arrhythmias by modifying the autonomic innervation of the heart. This procedure is particularly used for patients with vasovagal syncope, functional bradycardia, and other conditions where excessive vagal tone is implicated.

Background

The autonomic nervous system (ANS) plays a crucial role in regulating heart rate and rhythm. It consists of the sympathetic nervous system and the parasympathetic nervous system. The parasympathetic nervous system, primarily through the vagus nerve, can cause a decrease in heart rate. In some individuals, excessive vagal activity can lead to symptomatic bradycardia or syncope.

Cardioneuroablation targets the ganglionated plexi (GP) within the heart, which are clusters of autonomic nerves. By ablating these areas, the procedure aims to reduce the influence of the parasympathetic nervous system on the heart, thereby alleviating symptoms.

Procedure

The procedure is typically performed in an electrophysiology laboratory. It involves the use of catheter ablation techniques, where catheters are inserted through the femoral vein and guided to the heart. The specific areas targeted for ablation are identified using electrophysiological mapping.

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Autonomic nervous system ablation sites

Once the ganglionated plexi are located, radiofrequency energy is applied to ablate these areas. The goal is to selectively reduce the parasympathetic input to the heart without affecting the sympathetic input, thus achieving a more balanced autonomic tone.

Indications

Cardioneuroablation is indicated for patients who experience recurrent syncope or symptomatic bradycardia that is refractory to medical management. It is particularly useful in cases where the symptoms are attributed to excessive vagal activity.

Outcomes

Studies have shown that cardioneuroablation can be effective in reducing the frequency of syncope episodes and improving quality of life in affected patients. However, the long-term outcomes and potential risks are still being evaluated in clinical trials.

Risks and Considerations

As with any invasive procedure, cardioneuroablation carries risks, including infection, bleeding, and damage to cardiac tissue. There is also a risk of incomplete ablation, which may result in persistent symptoms.

Related pages

• Cardiac arrhythmia
• Vasovagal syncope
• Catheter ablation
• Autonomic nervous system