Cardioneural Ablation: Toward Achieving Uniformity in Nomenclature, Procedural Approaches and Outcome Measures.

Abstract

The cardiac autonomic nervous system plays a pivotal role in regulating heart function through a complex network of extrinsic and intrinsic components, including ganglionated plexi (GPs). Cardioneuroablation (CNA), a novel therapeutic approach targeting GPs, has emerged as a treatment for cardioinhibitory vasovagal syncope and select atrioventricular block cases. However, heterogeneity in anatomical nomenclature, GPs identification techniques, ablation strategies, and procedural endpoints limits standardization. While methods such as high-frequency stimulation, electroanatomic mapping, and anatomical guidance are used to localize GPs, each has limitations. CNA has demonstrated favorable short-term outcomes, yet concerns regarding long-term efficacy, reinnervation, and safety, particularly related to ventricular arrhythmia risk, remain. This review critically reviews the studies from the basic science of the cardiac autonomic nervous system to the latest clinical outcomes, highlighting the need for unified terminology, patient selection criteria, procedural techniques, and the necessity for long-term, multicenter studies to optimize CNA's safety and effectiveness.