Cardioneuroablation for the management of patients with recurrent vasovagal syncope and symptomatic bradyarrhythmias: the CNA-FWRD Registry

Tolga Aksu; Roderick Tung; Tom De Potter; Timothy M Markman; Pasquale Santangeli; Jeanne du Fay de Lavallaz; Jeffrey R Winterfield; Tina Baykaner; Daniel Alyesh; Jacqueline E Joza; Rakesh Gopinathannair; Patrick Badertscher; Duc H Do; Ayman Hussein; Jose Osorio; Thomas Dewland; Alexander Perino; Albert J Rodgers; Christopher DeSimone; Alberto Alfie; Brett D Atwater; David Singh; Kapil Kumar; Jonathan Salcedo; Jason S Bradfield; Gaurav Upadhyay; Nitesh Sood; Parikshit S Sharma; Sandeep Gautam; Vineet Kumar; Alexander Romeno Janner Dal Forno; Christopher E Woods; Moshe Rav-Acha; Chiara Valeriano; Sunil Kapur; Andres Enriquez; Sri Sundaram; Michael Glikson; Edward Gerstenfeld; Jonathan Piccini; Wendy S Tzou; William Sauer; Andre d'Avila; Kalyanam Shivkumar; Henry D Huang

doi:10.1007/s10840-024-01789-9

Cardioneuroablation for the management of patients with recurrent vasovagal syncope and symptomatic bradyarrhythmias: the CNA-FWRD Registry

J Interv Card Electrophysiol. 2024 Mar 18. doi: 10.1007/s10840-024-01789-9. Online ahead of print.

Authors

Tolga Aksu¹, Roderick Tung², Tom De Potter³, Timothy M Markman⁴, Pasquale Santangeli⁵, Jeanne du Fay de Lavallaz⁶, Jeffrey R Winterfield⁷, Tina Baykaner⁸, Daniel Alyesh⁹, Jacqueline E Joza¹⁰, Rakesh Gopinathannair¹¹, Patrick Badertscher⁶, Duc H Do¹², Ayman Hussein⁵, Jose Osorio^{13

14}, Thomas Dewland¹⁵, Alexander Perino⁸, Albert J Rodgers⁸, Christopher DeSimone¹⁶, Alberto Alfie¹⁷, Brett D Atwater¹⁸, David Singh¹⁹, Kapil Kumar²⁰, Jonathan Salcedo²¹, Jason S Bradfield¹², Gaurav Upadhyay²², Nitesh Sood²³, Parikshit S Sharma²⁴, Sandeep Gautam²⁵, Vineet Kumar¹⁸, Alexander Romeno Janner Dal Forno²⁶, Christopher E Woods²⁷, Moshe Rav-Acha²⁸, Chiara Valeriano³, Sunil Kapur²⁹, Andres Enriquez⁴, Sri Sundaram⁹, Michael Glikson²⁸, Edward Gerstenfeld¹⁵, Jonathan Piccini³⁰, Wendy S Tzou³¹, William Sauer²⁹, Andre d'Avila²⁰, Kalyanam Shivkumar¹², Henry D Huang³²

Affiliations

¹ Department of Cardiology, Yeditepe University Hospital, 34100, Istanbul, Turkey.
² The University of Arizona College of Medicine, Banner-University Medical Center, 755 E McDowell Road, Phoenix, AZ, 85006, USA.
³ Department of Cardiology, OLV Hospital, Aalst, Belgium.
⁴ Division of Cardiology, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia, USA.
⁵ Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH, USA.
⁶ Department of Cardiology, University Hospital Basel, Basel, Switzerland.
⁷ Division of Cardiology, Medical University of South Carolina, Charleston, SC, USA.
⁸ Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, CA, USA.
⁹ South Denver Cardiology Associates, 1000 SouthPark Drive, Littleton, CO, 80120, USA.
¹⁰ McGill University, Montreal, QC, Canada.
¹¹ Kansas City Heart Rhythm Institute, Overland Park, KS, USA.
¹² University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
¹³ Arrhythmia Institute at Grandview, Birmingham, AL, USA.
¹⁴ Heart Rhythm Clinical Research Solutions, Birmingham, AL, USA.
¹⁵ Electrophysiology Section, Division of Cardiology, Department of Internal Medicine, University of California, San Francisco, San Francisco, CA, USA.
¹⁶ Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA.
¹⁷ Electrophysiology Section, Cardiology Division, Hospital Nacional Profesor Alejandro Posadas, Av. Illia y Marconi S/N 1684, El Palomar, Moron, Province of Buenos Aires, Argentina.
¹⁸ Inova Heart and Vascular Institute, Falls Church, VA, USA.
¹⁹ The Queens Medical Center, Honolulu, HI, USA.
²⁰ Harvard Medical School, Boston, MA, USA.
²¹ Palo Alto Medical Foundation-Sutter Health, Palo Alto, CA, USA.
²² Center for Arrhythmia Care, Section of Cardiology, Pritzker School of Medicine, The University of Chicago Medicine, 5841 S. Maryland Avenue, MC 9024, Chicago, IL, 60637, USA.
²³ Arrhythmia Services, Southcoast Health, Fall River, MA, USA.
²⁴ Department of Cardiology, Rush University Medical Center, Chicago, IL, USA.
²⁵ Department of Cardiac Electrophysiology, University of Missouri-Columbia, Columbia, MO, USA.
²⁶ Serviço de Arritmia e Marcapasso - Hospital SOS Cardio - Florianópolis, Florianópolis, SC, Brazil.
²⁷ Department of Cardiology, California Pacific Medical Center, San Francisco, CA, USA.
²⁸ Jesselson Integrated Heart Center, Shaare Zedek Hospital, 9112102, Jerusalem, Israel.
²⁹ Cardiac Arrhythmia Service, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
³⁰ Duke Clinical Research Institute, Duke University Hospital, Durham, USA.
³¹ Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
³² Department of Cardiology, Rush University Medical Center, Chicago, IL, USA. Henry_d_huang@rush.edu.

PMID: 38499825
DOI: 10.1007/s10840-024-01789-9

Abstract

Background: Cardioneuroablation has been emerging as a potential treatment alternative in appropriately selected patients with cardioinhibitory vasovagal syncope (VVS) and functional AV block (AVB). However the majority of available evidence has been derived from retrospective cohort studies performed by experienced operators.

Methods: The Cardioneuroablation for the Management of Patients with Recurrent Vasovagal Syncope and Symptomatic Bradyarrhythmias (CNA-FWRD) Registry is a multicenter prospective registry with cross-over design evaluating acute and long-term outcomes of VVS and AVB patients treated by conservative therapy and CNA.

Results: The study is a prospective observational registry with cross-over design for analysis of outcomes between a control group (i.e., behavioral and medical therapy only) and intervention group (Cardioneuroablation). Primary and secondary outcomes will only be assessed after enrollment in the registry. The follow-up period will be 3 years after enrollment.

Conclusions: There remains a lack of prospective multicentered data for long-term outcomes comparing conservative therapy to radiofrequency CNA procedures particularly for key outcomes including recurrence of syncope, AV block, durable impact of disruption of the autonomic nervous system, and long-term complications after CNA. The CNA-FWRD registry has the potential to help fill this information gap.

Keywords: AV block; Cardioneuroablation; Ganglionated plexi; Syncope; Vasovagal syncope.