Cardioneuroablation in patients with vagally-mediated bradyarrhythmia
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Shalkar Smagulov 1 * , Assel Chinybayeva 2 , Abay Bakytzhanuly 3 , Alibek Toibayev 4 , Zhanasyl Suleymen 5 , Rinat Kamiyev 1 , Sanzhar Ibyldayev 1 , Ayan Abdrakhmanov 5
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1 Department of Arrhythmology, Medical Center Hospital of the President’s Affairs Administration of the Republic of Kazakhstan, Astana, KAZAKHSTAN2 Astana Medical University, Astana, KAZAKHSTAN3 Interventional Arrhythmology Department, University Medical Center, Astana, KAZAKHSTAN4 Department of Cardiac Surgery, Medical Center Hospital of the President’s Affairs Administration of the Republic of Kazakhstan, Astana, KAZAKHSTAN5 Department of Arrhythmology, National Coordination Center for Emergency Medicine, Astana, KAZAKHSTAN* Corresponding Author

Abstract

Aim: To assess the clinical efficacy and safety of cardioneuroablation (CNA) in patients with vagally-mediated dysfunction of sinus and atrioventricular (AV) nodes.
Methods: Between August 2023 and March 2025, 21 CNA procedures were performed in patients with autonomic dysfunction of the sinus node and functional second- and third-degree AV block. Clinical follow-up assessments were conducted at 3, 6, 12, and 24 months post-procedure, including 24-hour Holter monitoring and validated quality-of-life questionnaires.
Results: A total of 21 patients (mean age 37.4 ± 10.2 years) were included. CNA resulted in a significant increase in mean heart rate (HR) from 53.2 ± 9.6 beats per minute (bpm) to 70.4 ± 7.8 bpm (mean difference +17.1 bpm; 95% confidence interval [CI]: 13.5-20.8; p < 0.001; Cohen’s d = 2.13). Significant improvement in antegrade AV conduction (Wenckebach point: 541.9 ± 139.9 to 393.8 ± 63.7 ms; p < 0.001; d = 1.34) and corrected sinus node recovery time (cSNRT: 524.5 ± 273.1 to 320.5 ± 76.9 ms; p = 0.030) was observed. PR, AH, and HV intervals showed no significant changes (all p > 0.05). All six patients with prior syncope remained syncope-free throughout follow-up. Statistically significant improvement was observed in all five EQ-5D domains (p ≤ 0.025).
Conclusion: In selected patients with confirmed vagally mediated bradyarrhythmias, CNA is a feasible catheter-based procedure that may reduce the need for permanent pacemaker implantation. These preliminary results from a single-center pilot cohort study demonstrate significant improvement in HR, electrophysiological parameters, and health-related quality of life. Confirmation in larger multicenter controlled studies is required before broader clinical implementation.

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This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Article Type: Original Article

ELECTRON J GEN MED, Volume 23, Issue 5, October 2026, Article No: em758

https://doi.org/10.29333/ejgm/19568

Publication date: 11 Oct 2026

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