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Cardioneuroablation for the management of patients with recurrent vasovagal syncope and symptomatic bradyarrhythmias: the CNA-FWRD Registry

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Abstract

Background

Cardioneuroablation has been emerging as a potential treatment alternative in appropriately selected patients with cardioinhibitory vasovagal syncope (VVS) and functional AV block (AVB). However the majority of available evidence has been derived from retrospective cohort studies performed by experienced operators.

Methods

The Cardioneuroablation for the Management of Patients with Recurrent Vasovagal Syncope and Symptomatic Bradyarrhythmias (CNA-FWRD) Registry is a multicenter prospective registry with cross-over design evaluating acute and long-term outcomes of VVS and AVB patients treated by conservative therapy and CNA.

Results

The study is a prospective observational registry with cross-over design for analysis of outcomes between a control group (i.e., behavioral and medical therapy only) and intervention group (Cardioneuroablation). Primary and secondary outcomes will only be assessed after enrollment in the registry. The follow-up period will be 3 years after enrollment.

Conclusions

There remains a lack of prospective multicentered data for long-term outcomes comparing conservative therapy to radiofrequency CNA procedures particularly for key outcomes including recurrence of syncope, AV block, durable impact of disruption of the autonomic nervous system, and long-term complications after CNA. The CNA-FWRD registry has the potential to help fill this information gap.

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Author information

Authors and Affiliations

  1. Department of Cardiology, Yeditepe University Hospital, 34100, Istanbul, Turkey

    Tolga Aksu

  2. The University of Arizona College of Medicine, Banner-University Medical Center, 755 E McDowell Road, Phoenix, AZ, 85006, USA

    Roderick Tung

  3. Department of Cardiology, OLV Hospital, Aalst, Belgium

    Tom De Potter & Chiara Valeriano

  4. Division of Cardiology, University of Pennsylvania, Hospital of the University of Pennsylvania, Philadelphia, USA

    Timothy M. Markman & Andres Enriquez

  5. Section of Cardiac Pacing and Electrophysiology, Heart and Vascular Institute, Cleveland Clinic Foundation, Cleveland, OH, USA

    Pasquale Santangeli & Ayman Hussein

  6. Department of Cardiology, University Hospital Basel, Basel, Switzerland

    Jeanne du Fay de Lavallaz & Patrick Badertscher

  7. Division of Cardiology, Medical University of South Carolina, Charleston, SC, USA

    Jeffrey R. Winterfield

  8. Department of Medicine, Division of Cardiovascular Medicine, Stanford University, Stanford, CA, USA

    Tina Baykaner, Alexander Perino & Albert J. Rodgers

  9. South Denver Cardiology Associates, 1000 SouthPark Drive, Littleton, CO, 80120, USA

    Daniel Alyesh & Sri Sundaram

  10. McGill University, Montreal, QC, Canada

    Jacqueline E. Joza

  11. Kansas City Heart Rhythm Institute, Overland Park, KS, USA

    Rakesh Gopinathannair

  12. University of California Los Angeles (UCLA) Cardiac Arrhythmia Center, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA

    Duc H. Do, Jason S. Bradfield & Kalyanam Shivkumar

  13. Arrhythmia Institute at Grandview, Birmingham, AL, USA

    Jose Osorio

  14. Electrophysiology Section, Division of Cardiology, Department of Internal Medicine, University of California, San Francisco, San Francisco, CA, USA

    Thomas Dewland & Edward Gerstenfeld

  15. Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA

    Christopher DeSimone

  16. Electrophysiology Section, Cardiology Division, Hospital Nacional Profesor Alejandro Posadas, Av. Illia y Marconi S/N 1684, El Palomar, Moron, Province of Buenos Aires, Argentina

    Alberto Alfie

  17. Inova Heart and Vascular Institute, Falls Church, VA, USA

    Brett D. Atwater & Vineet Kumar

  18. The Queens Medical Center, Honolulu, HI, USA

    David Singh

  19. Harvard Medical School, Boston, MA, USA

    Kapil Kumar & Andre d’Avila

  20. Palo Alto Medical Foundation-Sutter Health, Palo Alto, CA, USA

    Jonathan Salcedo

  21. Center for Arrhythmia Care, Section of Cardiology, Pritzker School of Medicine, The University of Chicago Medicine, 5841 S. Maryland Avenue, MC 9024, Chicago, IL, 60637, USA

    Gaurav Upadhyay

  22. Arrhythmia Services, Southcoast Health, Fall River, MA, USA

    Nitesh Sood

  23. Department of Cardiology, Rush University Medical Center, Chicago, IL, USA

    Parikshit S. Sharma & Henry D. Huang

  24. Department of Cardiac Electrophysiology, University of Missouri-Columbia, Columbia, MO, USA

    Sandeep Gautam

  25. Serviço de Arritmia e Marcapasso - Hospital SOS Cardio - Florianópolis, Florianópolis, SC, Brazil

    Alexander Romeno Janner Dal Forno

  26. Department of Cardiology, California Pacific Medical Center, San Francisco, CA, USA

    Christopher E. Woods

  27. Jesselson Integrated Heart Center, Shaare Zedek Hospital, 9112102, Jerusalem, Israel

    Moshe Rav-Acha & Michael Glikson

  28. Cardiac Arrhythmia Service, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, USA

    Sunil Kapur & William Sauer

  29. Duke Clinical Research Institute, Duke University Hospital, Durham, USA

    Jonathan Piccini

  30. Division of Cardiology, University of Colorado Anschutz Medical Campus, Aurora, CO, USA

    Wendy S. Tzou

  31. Heart Rhythm Clinical Research Solutions, Birmingham, AL, USA

    Jose Osorio

Authors
  1. Tolga Aksu
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  2. Roderick Tung
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  3. Tom De Potter
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  37. Sri Sundaram
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  39. Edward Gerstenfeld
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  40. Jonathan Piccini
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  41. Wendy S. Tzou
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  42. William Sauer
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  43. Andre d’Avila
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  44. Kalyanam Shivkumar
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  45. Henry D. Huang
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Corresponding author

Correspondence to Henry D. Huang.

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Aksu, T., Tung, R., De Potter, T. et al. Cardioneuroablation for the management of patients with recurrent vasovagal syncope and symptomatic bradyarrhythmias: the CNA-FWRD Registry. J Interv Card Electrophysiol (2024). https://doi.org/10.1007/s10840-024-01789-9

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