Cardioneuroablation: Catheter Treatment for Fainting With a Slow Heartbeat

Table of Contents

1. What the Procedure Does
2. The Conditions It Has Been Studied In
3. Age Groups in the Studies
4. The Randomized Trials
5. Pooled Analyses and Large Registries
6. Complications Reported
7. What Is Not Known About the Long Term
8. How It Compares With Pacemakers
9. What Guidelines and Expert Statements Say
10. The Older Treatments for Reflex Fainting
11. Key Research Papers
12. Connections
13. Featured Videos

What the Procedure Does

The heart has its own small nervous system. Branches of the vagus nerve end in nerve cell clusters called ganglionated plexi, which sit in pads of fat on the outer surface of the two upper chambers (the atria), close to the heart’s natural pacemaker (the sinus node) and to the junction that passes each beat down to the lower chambers (the atrioventricular node). The 2024 expert statement on the procedure explains that the parasympathetic nerve cells which slow the heart have their cell bodies in these clusters, on the heart itself, whereas the cell bodies of the speeding-up (sympathetic) nerves lie outside the heart. That anatomical difference is the whole idea: heat delivered from inside the atria can reach the clusters through the thin atrial wall and reduce the vagal braking input to the sinus node and the atrioventricular node.

The procedure itself resembles other catheter ablations for heart rhythm problems. Thin catheters are passed through a vein, usually in the groin, into the heart. The operator maps the inside of the atria, finds the places where the nerve clusters are thought to lie — by anatomy, by the shape of the electrical signals recorded there, by stimulating the site and watching the heartbeat slow, or by stimulating the vagus nerve from outside the heart — and applies radiofrequency energy to those spots. Work in the left atrium needs a puncture through the wall between the two atria. Some teams treat the right atrium only, some the left only, and many both. The expert statement describes a rise in resting heart rate, a weaker response to the drug atropine afterwards, and a shortened conduction time through the atrioventricular node as signs that the vagal input has been reduced; it also notes that there is still no single validated sign that the job is complete.

The 2026 state-of-the-art review states that the procedure was first introduced in 2005 by a team in Brazil as an endocardial (from inside the heart) radiofrequency treatment for reflex fainting, functional atrioventricular block and sinus node dysfunction. It is sometimes called cardioneural ablation or ganglionated plexus ablation.

The Conditions It Has Been Studied In

Reflex (vasovagal) fainting with a cardioinhibitory response. In vasovagal fainting, a reflex makes the blood vessels relax (the vasodepressor part), slows the heart (the cardioinhibitory part), or both. Cardioneuroablation addresses only the heart-slowing part. Most studies enrolled people whose fainting came with a long pause in the heartbeat, documented during a tilt test or on a heart monitor. In the randomized trial from Warsaw, patients had cardioinhibitory or mixed vasovagal fainting and a positive atropine test. The expert statement summarises the selection used there: a pause of more than 3 seconds or a heart rate under 40 beats per minute with symptoms, and a rise of more than 25% in heart rate after intravenous atropine, which shows the slowing is driven by the vagus nerve rather than by a diseased sinus node. The same statement describes the procedure as lacking a strong rationale when the blood-vessel (vasodepressor) part of the faint dominates.

Functional atrioventricular block. Atrioventricular block means beats from the upper chambers fail to reach the lower chambers. In most people it reflects disease of the conduction system itself (intrinsic block), which is treated with a pacemaker (see Heart Block). In a smaller group the block is “functional”: it appears at rest or in sleep, disappears with exercise or atropine, and is driven by the vagus nerve. The PIRECNA registry collected 130 such patients from 20 centres. The procedure reversed the block at the time in 96.2% of cases. Over a median of 300 days, 17 of the 125 patients with initial success (14%) had either the block come back (9) or new fainting (8), and 4 of them received a pacemaker.

Sinus node dysfunction of vagal origin. Some people have long pauses or a very slow heartbeat from the sinus node because vagal tone is high, not because the node is worn out. A 2026 pooled analysis of 19 observational studies, with 482 patients who had functional sinus node dysfunction or atrioventricular block (mean age 38 years), found a pooled recurrence rate of 13.1% over a mean of about 16 months, and 9.7% in the sinus node subgroup. The authors rated the certainty of this evidence as low. The 2024 expert statement describes the procedure for these vagally driven slow rhythms, outside fainting, as investigational.

Age Groups in the Studies

Most people treated in the studies were young or middle-aged. The mean age was 38 years in the Warsaw randomized trial, 39.8 years across the 14 studies in a 2022 pooled analysis and a median of 39.6 years in a 2025 pooled analysis. The expert statement notes that people over 60 have been poorly represented, and that some studies in older patients found less rise in heart rate, more recurrences or no gain in quality of life.

Several cohorts have looked at age directly, with mixed findings:

• The ELEGANCE multicentre study treated 60 patients split into ages 18–40, 41–60 and over 60. Initial success was 93%, 88% were free of symptoms at a median of 8 months, and event-free survival did not differ between the age groups.
• A single-centre cohort from Warsaw of 209 patients (mean age 39.5) found 79.4% free of fainting over a median of 27 months. Age was not an independent predictor of recurrence, but patients aged 60 and over had less reduction in the number of faints, and all six patients who later received a pacemaker were over 50.
• A Spanish cohort of 50 patients found no difference in fainting or pacemaker implantation between those under 50 and those 50 and over, although the older group had lower heart rates after the procedure (68.9 against 80.4 beats per minute).
• In a Spanish multicentre series of 77 patients, being over 50 was linked to a lower risk of recurrence, and women had a higher risk than men.

Children and teenagers. The evidence here is small case series. A United States series described six patients aged 21 or under (median age 18.9) with vagal pauses or atrioventricular block; the median longest pause fell from 8.9 seconds before the procedure to 1.1 seconds at 6 months, and none fainted afterwards. A 2026 review of the procedure in children described early results as promising, stated that data in children are limited and that the long-term effects of disrupting the balance between the two branches of the nervous system remain unknown.

The Randomized Trials

ROMAN (Warsaw, 2023). This is the only published randomized trial that compared cardioneuroablation with a treatment that did not involve ablation. It enrolled 48 patients (mean age 38) with cardioinhibitory or mixed vasovagal fainting. Twenty-four had ablation of the nerve clusters in both atria and 24 continued optimal non-drug treatment. Over 2 years, 2 patients in the ablation group (8%) fainted again, against 13 in the control group (54%). After ablation the average heart rate on 24-hour monitoring was faster and heart-rate variability shifted toward less vagal activity. A quality-of-life score improved in the ablation group and stayed the same in the control group. The trial was open-label: patients and doctors knew who had the procedure, and the control group had no sham procedure. The authors called for larger studies.

Left atrium only against both atria (China, 2025). This trial randomized 80 patients with vasovagal fainting (mean age 38) to ablation in the left atrium only or in both atria. At 12 months, 87.5% and 90% respectively were free of fainting, which met the trial’s test for non-inferiority. The left-atrium approach was 13 minutes shorter, used less X-ray dose and fewer burns. Both arms received ablation, so this trial compared two techniques, not ablation against no ablation.

ROMAN2. The 2026 review describes a third randomized study of 40 patients that compared starting on the right atrium with starting on the left; its endpoint was the degree of vagal denervation achieved during the procedure, not fainting afterwards.

No randomized trial with a sham (fake) procedure has been completed. Trials comparing cardioneuroablation with pacing in patients who already carry a device, which allows blinding, are under way, according to the 2026 review.

Pooled Analyses and Large Registries

Most of the evidence comes from non-randomized studies: single-centre series and registries without a comparison group. Pooled analyses of these studies report high success rates, while some multicentre registries outside the pioneering centres report lower ones.

Pooled analyses (mostly non-randomized studies):

• 2022, 14 studies, 465 patients. Freedom from fainting after the procedure was 91.9%. Ablation limited to the right atrium did worse (81.5%) than left-atrium-only (94.0%) or both-atria (92.7%) ablation. The authors called for double-blind, sham-controlled trials.
• 2025, 27 observational studies plus 1 randomized trial, 1,153 patients. The weighted recurrence rate was 5.94% over a median follow-up of 21.4 months, and complications around the procedure occurred in 0.99%. Recurrence was higher with a right-atrium approach (15.78%).
• 2025, 37 studies, 1,585 patients. The pooled recurrence was 8.9%, with high variation between studies (I² = 74.4%). The authors noted that the findings rest mainly on non-randomized observational studies and that the variation limits how firm the conclusion can be.
• 2026 network analysis of 49 randomized trials, 2,798 patients, comparing many fainting treatments indirectly. Against conventional therapy, the odds ratio for fainting again was 0.077 for cardioneuroablation and 0.075 for pacing, and also lower for drug and physical therapies. The authors described the cardioneuroablation result as hypothesis-generating, because it rests on very little direct randomized evidence.

Multicentre registries with less favourable numbers:

• United States multicentre registry, 2025. 205 patients at 15 sites (mean age 47). At a mean of 14 months, 78% of those treated for fainting had no further faints, and 97% of the whole group had not needed a pacemaker. Complications are listed in the next section.
• Spanish multicentre study, 2024. 77 patients at 22 hospitals. Over a median of 12 months, 26 patients (33.8%) fainted again. The authors concluded that effectiveness was lower than previously reported.

The 2026 review set the figures side by side: freedom from fainting of roughly 80–94% at medium-term follow-up in selected patients, 66.2% in the Spanish multicentre series, and an overall certainty of evidence that it rated as low to moderate because of selection, reporting and outcome-measurement biases in open-label studies.

Complications Reported

The expert statement lists the complications expected from any catheter ablation in the atria: problems at the vein puncture site, a hole in the heart wall with blood collecting around the heart (tamponade), narrowing of large veins, injury to the phrenic nerve (which drives the diaphragm) or to a coronary artery, damage to the sinus node or atrioventricular node, pericarditis, injury to the oesophagus, bleeding and clots. It reports that damage to the artery supplying the sinus node has been described after ablation in both atria. Teams have given blood thinners for 1 to 3 months after left-atrial or both-atria ablation.

Reported rates differ by setting:

• The 2025 pooled analysis of 1,153 patients found a complication rate of 0.99%.
• The United States registry reported complications in 4.7% of 210 procedures: 2 cases of breathing failure needing mask ventilation, 1 paralysed right side of the diaphragm and 4 cases of sinus node dysfunction. Major adverse events occurred in 1.4%: 2 cases of bleeding around the heart and 1 death.
• The Spanish multicentre study reported complications in 5 of 77 patients (6.5%). Sinus node dysfunction occurred in 3 (3.9%), and 1 needed a pacemaker.
• Some single-centre series, such as a Brazilian cohort of 43 patients and a Chinese series of 39 patients treated in the left atrium, reported no major or procedure-related complications.

A fast heart rate afterwards. A faster resting heart rate is the intended effect, but it can overshoot. According to the expert statement, symptomatic sinus tachycardia was reported in 2–23% of patients in early studies; in a more recent series it occurred in 27%, and 7% needed long-term treatment with a beta-blocker or ivabradine. In the other patients the heart rate settled to a level without symptoms within 2 to 18 months.

Cardioneuroablation is performed for a condition that is rarely life-threatening. The 2026 review makes the point that, for this reason, the acceptable level of harm is low.

What Is Not Known About the Long Term

Follow-up is short. Most studies followed patients for 1 to 3 years. The expert statement calls for follow-up of 3 to 5 years. The 2026 review states that no series has reported outcomes beyond five years. The longest early data come from the Brazilian team: in 43 patients, 3 spontaneous faints occurred over a mean of about 45 months; in a later group of 83 patients (70% treated for vagally triggered atrial fibrillation, 30% for reflex fainting), 80% were free of symptoms at 40 months.

Re-innervation. Damaged nerve fibres can regrow. The procedure aims at the nerve cell bodies in the clusters because damage there is more lasting than damage to the fibres alone. In the 83-patient Brazilian cohort, heart-rate variability on 24-hour monitoring was still clearly reduced 2 years after the procedure and did not differ between years 1 and 2, which the authors read as regrowth having stopped. The expert statement notes that late return of symptoms after a long symptom-free period may be a sign of re-innervation, and that some recurrences after ablation turn out to be of the blood-vessel (vasodepressor) type, which ablation does not address.

Heart rate and long-term health. The procedure leaves the heart with less vagal control: a higher resting rate and lower heart-rate variability. A 2024 review by electrophysiologists argued that in healthy populations a higher heart rate is associated with more cardiovascular events and higher mortality, that a lasting imbalance between the two branches of the nervous system may affect heart rhythm, and that sham-controlled trials are needed. The expert statement compared the state after the procedure with conditions that have a similar pattern of fast heart rate and low variability, such as nerve damage to the heart in diabetes, which carries higher mortality. It states that it is not yet known whether people after cardioneuroablation share that higher risk, and that the possibility of unknown long-term risks is to be discussed with patients before the procedure. It also reports that in animal models, ablation of these heart nerve cells increased vulnerability to dangerous ventricular rhythms; the 2026 review adds that in a pig model this happened during a blocked coronary artery, and that no clinical signal of more sudden death has appeared in people.

The expectation effect. Fainting is unusually responsive to expectation and to the attention that comes with a procedure. Pacemakers for vasovagal fainting are the cautionary example. Early open trials found large benefits, but in the double-blind VPS II trial, in which every patient had a pacemaker implanted and only half had it switched on, 42% of the pacing-off group and 33% of the pacing-on group fainted within 6 months, a difference that was not statistically significant. A 2007 pooled analysis of 9 pacing trials found a large effect in unblinded trials (odds ratio 0.09) and none in double-blind trials (0.83). Because no sham-controlled cardioneuroablation trial has been completed, the 2026 review states that the specific effect of ablation cannot yet be separated from a placebo effect; it also notes that the lasting changes in heart rate and atropine response after ablation are objective, which a placebo would not produce.

How It Compares With Pacemakers

A pacemaker does not stop the reflex. It steps in when the heart slows and keeps it beating, which prevents the pause but not the drop in blood pressure from relaxed vessels. Cardioneuroablation tries to reduce the slowing itself and leaves no device behind. Neither treats the vasodepressor part of a faint.

Pacing trials (not compared with ablation). In ISSUE-3, a double-blind trial in patients aged 40 and over with fainting and a recorded pause of at least 3 seconds (or 6 seconds without fainting), the estimated 2-year recurrence was 57% with the pacemaker off and 25% with it on. These results, and the SPAIN trial described on the Syncope page, are the basis for pacing in older patients with cardioinhibitory fainting.

Direct comparisons, all non-randomized:

• Multicentre comparison, 162 patients (2022 online, 2025 in print). 61 had ablation at one centre and 101 received pacemakers at four other centres; mean age 36. At 1 year, 97% after ablation and 89% after pacing were free of fainting. After adjustment the difference was not statistically significant (hazard ratio 0.27, 95% confidence interval 0.06–1.24), and adverse events did not differ significantly. The 2026 review notes a commentary arguing that the pacing group included more mixed-type patients and a mix of pacing methods, which may have disadvantaged pacing.
• Retrospective cohort, 80 patients over 40 (2026). 37 had ablation and 43 a dual-chamber pacemaker with closed-loop stimulation. The ablation group was younger (mean 49.9 against 65.0 years). Over a mean of 3.8 years, 89.2% and 79.1% were free of fainting, a difference that was not statistically significant (hazard ratio 0.45, 95% confidence interval 0.14–1.46). No major adverse events were seen in either group.

Indirect comparison. The 2026 network analysis, which compares treatments across separate trials rather than head to head, gave similar odds ratios against conventional therapy for ablation (0.077) and pacing (0.075), ranked dual-chamber closed-loop pacing highest, and described the ablation result as hypothesis-generating.

The 2026 review states that the numerical edge for ablation in these studies cannot be read as equivalence or superiority, and that permanent pacing remains the only guideline-endorsed therapy for cardioinhibitory reflex fainting in patients who meet standard criteria. Randomized comparisons are in progress: the expert statement describes SAN.OK (sinus node dysfunction) and TELE-SPACER (atrioventricular block), both comparing ablation with pacemaker implantation, and the review describes GENTLE-PACE and PANACEA. Ablation in the Warsaw cohort led to a pacemaker later in some older patients, and in the United States registry 3% needed one during follow-up.

What Guidelines and Expert Statements Say

2024 EHRA/HRS/APHRS/LAHRS scientific statement. The European Heart Rhythm Association (EHRA), the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society and the Latin American Heart Rhythm Society published a joint scientific statement on cardioneuroablation in 2024. Its writing committee position, read in full text for this page, says:

• With only one small randomized trial and small to moderate observational studies, strong recommendations on the use of the procedure cannot be made.
• Limited data report fewer faints in younger patients with severe, unpredictable, recurrent cardioinhibitory fainting (a documented pause of more than 3 seconds with symptoms, more than 6 seconds without, or more than 3 seconds during a tilt test) when non-invasive treatments have failed; randomized trials in this group are needed to confirm its value.
• The procedure seems inappropriate when the blood-vessel (vasodepressor) part of the faint dominates.
• For vagally driven sinus node dysfunction and atrioventricular block, the procedure is to be treated as investigational and, if used in severely symptomatic patients after other treatments fail, done within controlled trials.
• Well-designed randomized and sham-controlled trials are needed, as is follow-up of 3 to 5 years, and patients are to be told about the possibility of unknown long-term risks.

ESC guidelines, as described in that statement. The expert statement reports that the 2018 European Society of Cardiology (ESC) syncope guideline mentioned cardioneuroablation only as a treatment lacking strong evidence, and that the 2021 ESC pacing guideline recommends dual-chamber pacing for people over 40 with severe, unpredictable, recurrent fainting and a dominant cardioinhibitory response. The full text of the 2018 and 2021 guidelines was not read for this page; these points come from the 2024 statement.

2026 review. The state-of-the-art review states that cardioneuroablation has not yet received a formal guideline recommendation, and that sham-controlled results will be needed before that changes.

The Older Treatments for Reflex Fainting

Cardioneuroablation is studied in people whose fainting continued despite the usual measures. Those measures, and their evidence, are covered on the Syncope page; the points most relevant here are summarised below.

• Non-drug measures. Education, recognising warning signs, fluids and salt, and counterpressure manoeuvres (crossing the legs and tensing, gripping the hands) are the first steps described in syncope guidelines. The control group of the Warsaw trial received optimal non-drug treatment.
• Beta-blockers did not help in the POST trials (randomized, placebo-controlled). In the original Prevention of Syncope Trial, 208 patients received metoprolol or placebo for a year, and the chance of fainting again did not differ. POST 5 (2026) then tested metoprolol in 51 patients aged 40 and over, because an earlier hint suggested older patients might benefit: 31% on metoprolol and 40% on placebo fainted (P = 0.69). Pooling 173 patients aged 40 and over from 4 trials, 34% in each group fainted again. The authors wrote that the results may lead guidelines to remove their weak recommendation of beta-blockers for this group.
• Other drugs. Midodrine and fludrocortisone have been tested in POST 4 and POST 2; the numbers are on the Syncope page.
• Pacemakers. See the comparison section above.

Key Research Papers

1. Piotrowski R, Baran J, Sikorska A, Krynski T, Kulakowski P. Cardioneuroablation for Reflex Syncope: Efficacy and Effects on Autonomic Cardiac Regulation-A Prospective Randomized Trial. JACC Clin Electrophysiol. 2023;9(1):85-95. PubMed PMID: 36114133
2. Tu B, Chen A, Cai S, Zhang Z, Zhou L, Lai Z, et al. The Efficacy of Left Atrial vs Biatrial Cardioneuroablation in Patients With Vasovagal Syncope: A Randomized Clinical Trial. JACC Clin Electrophysiol. 2025;11(6):1265-1276. PubMed PMID: 40117421
3. Aksu T, Brignole M, Calo L, Debruyne P, Di Biase L, Deharo JC, et al. Cardioneuroablation for the treatment of reflex syncope and functional bradyarrhythmias: A Scientific Statement of the European Heart Rhythm Association (EHRA) of the ESC, the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS) and the Latin American Heart Rhythm Society (LAHRS). Europace. 2024;26(8):euae206. PubMed PMID: 39082698
4. San Antonio R, Almonte JI, García-Filloy C, Mercé J, Rodríguez-García J, Rodríguez-Silva J, et al. Cardioneuroablation for Reflex Syncope and Functional Bradyarrhythmias: A State-of-the-Art Review. J Clin Med. 2026;15(15):6012. PubMed PMID: 42590115
5. Vandenberk B, Lei LY, Ballantyne B, Vickers D, Liang Z, Sheldon RS, et al. Cardioneuroablation for vasovagal syncope: A systematic review and meta-analysis. Heart Rhythm. 2022;19(11):1804-1812. PubMed PMID: 35716859
6. Armani Prata A, Katsuyama E, Scardini P, Antunes V, Granja J, Coan AC, et al. Cardioneuroablation in patients with vasovagal syncope: An updated systematic review and meta-analysis. Heart Rhythm. 2025;22(2):526-535. PubMed PMID: 39067734
7. Ababei A, Ursu CG, Bistriceanu MIA, Andreescu DI, Iurea IM, Budeanu B, et al. Cardioneuroablation for Vasovagal Syncope: An Updated Systematic Review and Single-Arm Meta-Analysis. Biomedicines. 2025;13(7):1758. PubMed PMID: 40722829
8. Wang H, Zhang Y, Liao S, Zhang H, Huang X. Comparing Physical, Pharmacological, Pacemaker, and Cardioneuroablation Therapies for Patients with Vasovagal Syncope: A systematic review and network meta-analysis. Int J Cardiol Heart Vasc. 2026;63:101885. PubMed PMID: 41716718
9. Chen A, Zhang T, Sun H, Tu B, Maimaitijiang P, Wang X, et al. Efficacy and safety of cardioneuroablation as a treatment for patients with functional bradyarrhythmia: a systematic review and meta-analysis. Int J Cardiol Heart Vasc. 2026;63:101897. PubMed PMID: 41798792
10. Aksu T, Piotrowski R, Tung R, De Potter T, Markman TM, du Fay de Lavallaz J, et al. Procedural and Intermediate-term Results of the Electroanatomical-guided Cardioneuroablation for the Treatment of Supra-Hisian Second- or Advanced-degree Atrioventricular Block: the PIRECNA multicentre registry. Europace. 2024;26(7):euae164. PubMed PMID: 38954426
11. Tung R, Pujol-Lopez M, Locke AH, Alyesh DM, Sundaram S, Shah AD, et al. Cardioneural Ablation for Functional Bradycardia and Vasovagal Syncope: Outcomes From the U.S. Multicenter CNA Registry. JACC Clin Electrophysiol. 2025;11(8):1683-1695. PubMed PMID: 40392665
12. Barrio-Lopez MT, Álvarez-Ortega C, Minguito-Carazo C, Franco E, García-Granja PE, Alcalde-Rodríguez Ó, et al. Predictors of Clinical Success of Cardioneuroablation in Patients With Syncope: Results of a Multicenter Study. JACC Clin Electrophysiol. 2024;10(12):2711-2724. PubMed PMID: 39453292
13. Francia P, Viveros D, Falasconi G, Penela D, Soto-Iglesias D, Martí-Almor J, et al. Clinical impact of aging on outcomes of cardioneuroablation for reflex syncope or functional bradycardia: Results from the cardionEuroabLation: patiEnt selection, imaGe integrAtioN and outComEs-The ELEGANCE multicenter study. Heart Rhythm. 2023;20(9):1279-1286. PubMed PMID: 37329936
14. Kulakowski P, Sikorska A, Krynski T, Niedzwiedz M, Soszynska M, Baran J, et al. Older age is not an independent predictor of syncope recurrence following cardioneuroablation for reflex syncope. J Interv Card Electrophysiol. 2026;69(1):71-79. PubMed PMID: 40986140
15. Minguito-Carazo C, Martínez-Alday JD, Martínez-Sande JL, García Seara J, Fernández López XA, Shangutov O, et al. Effect of age on clinical impact and mid-term denervation in patients undergoing cardioneuroablation. Sci Rep. 2024;14(1):27546. PubMed PMID: 39528539
16. Choi NH, Hong J, Moak JP. Cardioneuroablation for pediatric patients with functional sinus node dysfunction and paroxysmal atrioventricular block. J Cardiovasc Electrophysiol. 2024;35(2):221-229. PubMed PMID: 38038245
17. Cohen MI, Cohen JA. Cardioneuroablation for children with syncope. Curr Opin Cardiol. 2026;41(4):345-352. PubMed PMID: 42186407
18. Pachon JC, Pachon EI, Cunha Pachon MZ, Lobo TJ, Pachon JC, Santillana TG. Catheter ablation of severe neurally meditated reflex (neurocardiogenic or vasovagal) syncope: cardioneuroablation long-term results. Europace. 2011;13(9):1231-42. PubMed PMID: 21712276
19. Pachon-M JC, Pachon-M EI, Pachon CTC, Santillana-P TG, Lobo TJ, Pachon-M JC, et al. Long-Term Evaluation of the Vagal Denervation by Cardioneuroablation Using Holter and Heart Rate Variability. Circ Arrhythm Electrophysiol. 2020;13(12):e008703. PubMed PMID: 33198486
20. Ge N, Chen Y, Han J. Ganglionated plexus ablation of the left atrium for refractory vasovagal syncope: Analysis of the Safety, Effectiveness and Related Factors. Indian Pacing Electrophysiol J. 2026;26(1):15-19. PubMed PMID: 41407203
21. Chakraborty P, Chen PS, Gollob MH, Olshansky B, Po SS. Potential consequences of cardioneuroablation for vasovagal syncope: A call for appropriately designed, sham-controlled clinical trials. Heart Rhythm. 2024;21(4):464-470. PubMed PMID: 38104955
22. Connolly SJ, Sheldon R, Thorpe KE, Roberts RS, Ellenbogen KA, Wilkoff BL, et al. Pacemaker therapy for prevention of syncope in patients with recurrent severe vasovagal syncope: Second Vasovagal Pacemaker Study (VPS II): a randomized trial. JAMA. 2003;289(17):2224-9. PubMed PMID: 12734133
23. Sud S, Massel D, Klein GJ, Leong-Sit P, Yee R, Skanes AC, et al. The expectation effect and cardiac pacing for refractory vasovagal syncope. Am J Med. 2007;120(1):54-62. PubMed PMID: 17208080
24. Brignole M, Menozzi C, Moya A, Andresen D, Blanc JJ, Krahn AD, et al. Pacemaker therapy in patients with neurally mediated syncope and documented asystole: Third International Study on Syncope of Uncertain Etiology (ISSUE-3): a randomized trial. Circulation. 2012;125(21):2566-71. PubMed PMID: 22565936
25. Gopinathannair R, Olshansky B, Turagam MK, Gautam S, Futyma P, Akella K, et al. Permanent pacing versus cardioneuroablation for cardioinhibitory vasovagal syncope. J Interv Card Electrophysiol. 2025;68(2):203-210. PubMed PMID: 36562915
26. Álvarez-Ortiz A, Mariño-Murillo LE, Zerpa JC, Lopez-Lopez JP, Álvarez-Mariño MA, Aksu T. Cardioneuroablation versus cardiac pacemaker in the management of dominant cardioinhibitory vasovagal syncope: a retrospective cohort study. J Interv Card Electrophysiol. 2026;69(5):999-1010. PubMed PMID: 42008055
27. Sheldon R, Connolly S, Rose S, Klingenheben T, Krahn A, Morillo C, et al. Prevention of Syncope Trial (POST): a randomized, placebo-controlled study of metoprolol in the prevention of vasovagal syncope. Circulation. 2006;113(9):1164-70. PubMed PMID: 16505178
28. Sepehrvand N, Hatami S, Raj SR, Semeniuk L, Hamzeh R, Ayala-Paredes F, et al. Beta-Blockers for Vasovagal Syncope in Aging Subjects: A Randomized Controlled Trial and Individual Patient Data Meta-Analysis of Clinical Trials. CJC Open. 2026;8(8):939-947. PubMed PMID: 42609753

PubMed Topic Searches

1. PubMed: cardioneuroablation, randomized studies
2. PubMed: cardioneuroablation for atrioventricular block
3. PubMed: cardioneuroablation compared with pacing
4. PubMed: re-innervation after cardioneuroablation
5. PubMed: cardioneuroablation in children

Connections

• Cardiology — the cardiovascular section
• Syncope (Fainting) — types of fainting, red flags and the other treatments
• Heart Block — atrioventricular block and pacemakers
• Arrhythmia — heart rhythm problems in general
• Atrial Fibrillation — where catheter ablation in the atria is most used
• The Heart’s Electrical System — sinus node and atrioventricular node, animated
• The Baroreflex — the blood-pressure reflex behind fainting, animated
• Tilt Table Test — how the test that classifies a faint is done

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