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07. Syncope and Bradycardia
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32. Cardiovascular Nursing
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Procedural Strategy and Outcomes of Cardioneuromodulation in Vagally Mediated Syndromes
Session:
Sessão de Posters 09 - Síncope, ILR e cardioneuromodulação
Speaker:
Felipe Souza Leão
Congress:
CPC 2026
Topic:
C. Arrhythmias and Device Therapy
Theme:
07. Syncope and Bradycardia
Subtheme:
07.4 Syncope and Bradycardia - Treatment
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Felipe Leão; Tiago Constantino; Helena Fonseca; Sara Laginha; Helder Santos; Madalena Cruz; Guilherme Portugal; Paulo Osório; Ana Lousinha; Pedro Silva e Cunha; Bruno Valente; Mário Oliveira
Abstract
<p><span style="font-size:11pt"><span style="font-family:Cambria,serif">Cardioneuromodulation (CNM) seeks to modulate cardiac autonomic balance by targeting ganglionated plexi that mediate parasympathetic innervation of the atria. Its application spans hypervagotonic bradycardia, cardioinhibitory syncope and vagally mediated atrial arrhythmias, with emerging evidence supporting symptomatic improvement. Nevertheless, CNM techniques remain heterogeneous, and systematic descriptions of procedural strategy and its impact on physiological and clinical endpoints are still scarce.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Cambria,serif">Methods: We analysed consecutive CNM procedures in patients with hypervagotonic bradycardia, cardioinhibitory reflex syncope or paroxysmal atrial fibrillation with neurally mediated features. Right atrial (RA) and left atrial (LA) ganglionated plexi (GP) were ablated according to standard anatomic targets. For each procedure, we assessed GP distribution, number of ablation sites, immediate heart-rate (HR) response, syncope recurrence and safety. A patient-level analysis described clinical presentation and follow-up.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Cambria,serif">Results: Twenty-five patients underwent 28 CNM procedures (mean age 39.2 ± 12.9 years, 68% male): 20 for hypervagotonic bradycardia, 6 for cardioinhibitory syncope and 2 for paroxysmal atrial fibrillation with vagal features. Biatrial ablation was performed in 22 procedures (78.6%), LA-only in 3 (10.7%) and RA-only in 3 (10.7%). The median number of ablated GP was 2.5 (mean 2.8). In procedures with complete data, mean HR increased from 65.7 to 84.9 bpm immediately after CNM (Δ≈+19 bpm). Overall syncope recurrence occurred after 3 procedures (10.7%), all in hypervagotonic patients; no recurrences were observed in cardioinhibitory syncope or atrial fibrillation groups. No major procedural complications were documented.</span></span></p> <p><span style="font-size:11pt"><span style="font-family:Cambria,serif">Conclusion: CNM was predominantly performed using a biatrial strategy with ablation of multiple GP targets and produced a consistent acute HR increase. Clinical outcomes were favourable, with low syncope recurrence and no major complications. These findings provide a pragmatic description of procedural practice and support CNM as a therapeutic option in selected vagally mediated syndromes.</span></span></p>
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