ArticleJournal of cardiovascular development and disease2023
Shared Decision Making and Cardioneuroablation Allow Discontinuation of Permanent Pacing in Patients with Vagally Mediated Bradycardia.
Article in Journal of cardiovascular development and disease, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 12 papers, 2 of them syntheses that pooled it.
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The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
12 citing papers in PubMed, 2 syntheses or guidelines pooled it, 11 citations in OpenAlex.
- Systematic Review of Commercially Available Clinical CMUT-Based Systems for Use in Medical Ultrasound Imaging: Products, Applications, and Performance.Sensors (Basel, Switzerland) · 2025Pooled it
- 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 : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2024Guideline
- When 95% Atrial Pacing Does Not Mean Pacemaker Dependency.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2026Article
- Efficacy and safety of cardioneuroablation as a treatment for patients with functional bradyarrhythmia: a systematic review and meta-analysis.International journal of cardiology. Heart & vasculature · 2026Review
- Article
- Cardioneuroablation for Vasovagal Syncope: An Updated Systematic Review and Single-Arm Meta-Analysis.Biomedicines · 2025Review
- Clinical neurocardiology: defining the value of neuroscience-based cardiovascular therapeutics - 2024 update.The Journal of physiology · 2025Review
- Cardioneuroablation in the Management of Vagally Mediated Bradyarrhythmias-A Comprehensive Review of Ongoing Randomized Controlled Trials.Journal of clinical medicine · 2025Review
- 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 : European pacing, arrhythmias, and cardiac electrophysiology : journal of the working groups on cardiac pacing, arrhythmias, and cardiac cellular electrophysiology of the European Society of Cardiology · 2024Article
- Cardioneuroablation for Cardioinhibitory Vasovagal Syncope: Rationale, Approaches, and Its Role in Long-Term Management.Current cardiovascular risk reports · 2024Article
- GENTLE-PACE - A multicenter, randomized, double-blinded research study comparinG the Efficacy and safety of cardioNeuroablaTion vs. permanent pacing in patients with an implantabLE PACEmaker for symptomatic bradycardia.Cardiology journal · 2024Article
- TELE-SPACER - a randomized clinical trial protocol: Cardioneuroablation versus pacemaker implantation in the treatment of vagally-mediated atrio-ventricular block.Cardiology journal · 2024Article
Corrections and comments
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Authors and funding
13 authors at 9 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundSafe discontinuation of pacemaker therapy for vagally mediated bradycardia is a dilemma. The aim of the study was to present the outcomes of a proposed diagnostic and therapeutic process aimed at discontinuing or not restoring pacemaker therapy (PPM) in patients with vagally mediated bradycardia.
methodsThe study group consisted of two subgroups of patients with suspected vagally mediated bradycardia who were considered to have PPM discontinued or not to restore their PPM if cardioneuroablation (CNA) would successfully treat their bradycardia. A group of 3 patients had just their pacemaker explanted but reimplantation was suggested, and 17 patients had preexisting pacemakers implanted. An invasive electrophysiology study was performed. If EPS was negative, extracardiac vagal nerve stimulation (ECVS) was performed. Then, patients with positive ECVS received CNA. Patients with an implanted pacemaker had it programmed to pace at the lowest possible rate. After the observational period and control EPS including ECVS, redo-CNA was performed if pauses were induced. The decision to explant the pacemaker was obtained based on shared decision making (SDM).
resultsAfter initial clinical and electrophysiological evaluation, 17 patients were deemed eligible for CNA (which was then performed). During the observational period after the initial CNA, all 17 patients were clinically asymptomatic. The subsequent invasive evaluation with ECVS resulted in pause induction in seven (41%) patients, and these patients underwent redo-CNA. Then, SDM resulted in the discontinuation of pacemaker therapy or a decision to not perform pacemaker reimplantation in all the patients after CAN. The pacemaker was explanted in 12 patients post-CNA, while in 2 patients explantation was postponed. During a median follow-up of 18 (IQR: 8-22) months, recurrent syncope did not occur in the CNA recipients.
conclusionsPacemaker therapy in patients with vagally mediated bradycardia could be discontinued safely after CNA.
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