โก Quick Summary
This study explored the effectiveness of biatrial cardioneuroablation (CNA) guided by robotic magnetic navigation and artificial intelligence-based mapping in treating vagal bradyarrhythmias. The results indicated a significant improvement in patient outcomes, with most patients remaining free from symptoms without the need for pacemaker implantation over a follow-up period of approximately 12 months.
๐ Key Details
- ๐ฅ Participants: 12 patients aged 23-55 with drug-refractory vagally mediated bradyarrhythmias
- ๐งช Control Group: 10 medically managed patients with similar profiles
- โ๏ธ Technology: Robotic magnetic navigation and automated electrogram analysis
- ๐ Follow-up Duration: Mean follow-up of approximately 12 months
๐ Key Takeaways
- ๐ฌ Cardioneuroablation (CNA) is a promising alternative for patients with vagal bradyarrhythmias.
- ๐ค Robotic navigation and AI-based mapping enhance the precision of the procedure.
- ๐ Significant increase in resting sinus rate observed post-ablation.
- ๐ซ No acute complications were reported during the procedures.
- ๐ Recurrence of symptoms and need for pacemaker placement were lower in CNA-treated patients compared to controls.
- ๐ก๏ธ Safety and feasibility of the procedure were confirmed in this small cohort.
- ๐ Further research is needed to validate these findings in larger, prospective studies.
๐ Background
Vagal bradyarrhythmias can lead to debilitating symptoms such as syncope and significantly impact a patient’s quality of life. Traditional treatment options may not always be effective, prompting the exploration of cardioneuroablation (CNA) as a device-sparing alternative. This study aims to provide real-world data on the outcomes of CNA in patients with excessive vagal tone.
๐๏ธ Study
Conducted as a controlled observational study, this research evaluated 12 patients who underwent biatrial CNA. The procedures were guided by advanced technologies, including ultra-high-density electroanatomical mapping and automated fragmented-electrogram detection. A contemporaneous cohort of 10 patients receiving standard medical management served as a control group to assess the effectiveness of the intervention.
๐ Results
The study found that all CNA procedures were completed successfully without any acute complications. Patients experienced a substantial increase in their resting sinus rate following the ablation. Over the mean follow-up period of 12 months, the majority of patients treated with CNA remained free from symptomatic bradyarrhythmia or syncope, with a notably lower incidence of recurrence and pacemaker implantation compared to the control group. Importantly, no delayed complications were reported.
๐ Impact and Implications
The findings from this study suggest that biatrial CNA, when guided by robotic navigation and AI mapping, is a safe and effective treatment option for patients suffering from vagally mediated bradyarrhythmias. This approach not only improves patient outcomes but also reduces the need for invasive devices like pacemakers. As healthcare continues to evolve with technology, such innovative treatments could significantly enhance the quality of life for patients with similar conditions.
๐ฎ Conclusion
This study highlights the potential of biatrial cardioneuroablation as a viable treatment for vagal bradyarrhythmias, showcasing its safety and effectiveness in a real-world setting. The promising results warrant further investigation in larger, prospective studies to confirm the durability of these outcomes and assess any long-term risks associated with the procedure. The integration of advanced technologies in cardiac care is paving the way for improved patient management and outcomes.
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Biatrial cardioneuroablation guided by robotic magnetic navigation and artificial intelligence-based mapping in vagal bradyarrhythmias: A controlled observational study.
Abstract
PURPOSE: Reflex bradyarrhythmias and syncope related to excessive vagal tone may be refractory to conservative therapy and significantly impair quality of life. Cardioneuroablation (CNA) has emerged as a device-sparing alternative, but real-world outcome data remain limited.
METHODS: We retrospectively evaluated 12 consecutive patients (aged 23-55 years) with drug-refractory, vagally mediated bradyarrhythmias confirmed by tilt-table testing. All underwent biatrial CNA guided by ultra-high-density electroanatomical mapping with automated fragmented-electrogram detection and robotic magnetic navigation. A contemporaneous cohort of medically managed patients with comparable clinical profiles (nโ=โ10) served as a control group. The primary outcome was freedom from syncope or clinically significant bradyarrhythmia without pacemaker implantation. Secondary outcomes included procedural metrics, heart-rate changes, and recurrence during follow-up.
RESULTS: All CNA procedures were completed without acute complications and with minimal fluoroscopy exposure. Resting sinus rate increased substantially after ablation. Over a mean follow-up of approximately 12 months, most CNA-treated patients remained free of symptomatic bradyarrhythmia or syncope without requiring pacemaker implantation, whereas recurrence and pacemaker placement were less frequent compared with controls. No delayed complications were observed.
CONCLUSIONS: In this small, retrospective real-world cohort, biatrial CNA guided by automated electrogram analysis and robotic navigation was feasible, safe, and associated with short-term autonomic modulation and symptomatic improvement over approximately 12 months of follow-up in selected patients with vagally mediated bradyarrhythmias. These findings are exploratory and warrant confirmation in larger, prospective studies with longer follow-up to assess durability and reinnervation risk.
Author: [‘Cacciapuoti F’, ‘Crispo S’, ‘Ambrosino S’, ‘Pirozzi C’, ‘Munciguerra O’, ‘Nappo C’, ‘Caccavale N’, ‘Casolaro F’, ‘Volpicelli M’]
Journal: J Interv Card Electrophysiol
Citation: Cacciapuoti F, et al. Biatrial cardioneuroablation guided by robotic magnetic navigation and artificial intelligence-based mapping in vagal bradyarrhythmias: A controlled observational study. Biatrial cardioneuroablation guided by robotic magnetic navigation and artificial intelligence-based mapping in vagal bradyarrhythmias: A controlled observational study. 2026; (unknown volume):(unknown pages). doi: 10.1007/s10840-026-02241-w