Cardioneuroablation: an alternative to pacing in pediatric patients with bradycardia and syncope

Abstract Introduction Severe transient episodes of bradycardia followed by syncope are common in children and generally have a benign prognosis. However, some patients may experience prolonged episodes of asystole due to significant sinus pauses (SP) or paroxysmal atrioventricular block (AVB). Cardioneuroablation (CNA) is an intervention based on denervation of the epicardial ganglionic plexuses (GP) by radiofrequency ablation, interrupting the vagal parasympathetic input to the sinus node and the atrioventricular node. Objective To describe the methodology and role of CNA in the treatment of pediatric patients with functional AVB or SP. Methods Case series study in a single center. Patients aged 18 years or younger with SP or AVB, undergoing CNA between 2023 and 2024, were included. CNA was performed by cardiac navigator with minimal fluoroscopy and guided by anatomy and fractionated components. Results 10 patients were included (mean age: 13.8 years, min 11- max 17 years; 83.3% female). Four patients had prolonged PS, two with paroxysmal AVB, and four with both SP and AVB. Eight patients had a history of syncope. There were no complications during the procedure. The longest pause pre-CNA was 20 s (range: 4.9-120s) with a total of 12 documented pauses (range: 2-112) in the 6 months prior to CNA. Post-CNA, the mean longest pause was 1.1 s (range: 0.8-2.1 s) at 3-month follow-up. At 6 months, the mean longest pause was 1.1 s (range: 0.8-1.3 s) with no documented pauses. No patient developed post-ANC syncope or other bradycardia-related symptoms during follow-up. Conclusion CNA may be an effective alternative to pacemaker implantation in pediatric patients with syncope or significant symptoms secondary to PS or functional AVB.20sec sinus pause and CNA zones