ArticleJournal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing2025
Differential and synergistic effects of right and left atrial ganglionated plexi ablation in patients undergoing cardioneuroablation: results from the ELEGANCE multicenter study.
Article in Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.
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Who cites it
8 citing papers in PubMed.
- Recurrent vasovagal syncope treated with 2 sequential cardioneuroablation procedures.HeartRhythm case reports · 2026Article
- Cardioneuroablation for Reflex Syncope and Functional Bradyarrhythmias: A State-of-the-Art Review.Journal of clinical medicine · 2026Review
- Differential effects of right atrial ablation sites on vagal modulation of the sinus node during cardioneuroablation.Journal of interventional cardiac electrophysiology : an international journal of arrhythmias and pacing · 2026Article
- A tailored approach to cardioneuroablation for reflex syncope and functional bradycardia: results from the ELEGANCE multicentre study.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 · 2026Article
- State-of-the-art Laser Ablation for Cardiac Arrhythmias: Development and Future Perspective-A State-of-the-art Review.The Journal of innovations in cardiac rhythm management · 2025Review
- Cardioneuroablation for Vasovagal Syncope: An Updated Systematic Review and Single-Arm Meta-Analysis.Biomedicines · 2025Review
- Cardioneuroablation for Asystolic Reflex Syncope: How to Identify the Best Candidate and How to Predict Success.Arrhythmia & electrophysiology review · 2025Review
- Inappropriate Sinus Tachycardia Following Cardioneuroablation for Reflex Syncope: A Case Report and Review of the Literature Illustrating this Underappreciated Adverse Effect.Arrhythmia & electrophysiology review · 2025Article
Corrections and comments
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Authors and funding
20 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundCardioneuroablation (CNA) treats reflex syncope by ablating ganglionated plexi (GPs) either confined to the right (RA) or left atrium (LA), or accessible from both. We assessed whether GP ablation in one atrium affects parasympathetic modulation in the other and how ablation sequence (RA then LA, or vice-versa) impacts efficacy.
methodsTwo propensity-matched groups of patients with reflex syncope or functional bradycardia were analyzed. Group 1 received CNA in the RA first, followed by LA. Group 2 in the reverse order.
resultsThirty-four patients were enrolled. In group 1, RA ablation prompted a heart rate (HR) increase (49.8 ± 10.6 vs. 61.2 ± 13.8 bpm; p < 0.01) that was enhanced after LA ablation (60.3 ± 14.5 vs. 64.5 ± 14.4 bpm; p = 0.02). RA ablation did not reduce PR interval in any patient or modify the Wenckebach point (WP) (596 ± 269 vs. 609 ± 319 ms; p = 0.68), while additional LA ablation reduced PR interval in 3 patients and mean WP (611 ± 317 vs. 482 ± 191 ms; p = 0.03). In group 2, LA ablation increased HR (56.7 ± 6.6 vs. 76.4 ± 13.8 bpm; p < 0.01), with an additional effect of RA ablation (76.0 ± 16.5 vs. 85.4 ± 15.9 bpm; p < 0.01). LA ablation decreased PR interval in 3 patients and mean WP (512 ± 182 vs .399 ± 85 ms; p = 0.01). Further RA ablation did not decrease PR or WP. CNA success was 82% in group 1 and 100% in group 2 (p = 0.552). After 24.5 ± 6.1 months, 2 patients in group 1 vs. no patients in group 2 experienced symptom recurrence.
conclusionsBi-atrial CNA provides incremental benefits after both RA and LA ablation. Starting ablation in the LA provides the most significant effect on vagal modulation.
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