Efficacy and safety of cardioneuroablation as a treatment for patients with functional bradyarrhythmia: a systematic review and meta-analysis

Cardioneuroablation (CNA) is a novel procedure that shows promising results in patients with functional bradyarrhythmia, including functional sinus node dysfunction (SND) and atrioventricular block (AVB). We performed a systematic review and <i>meta</i>-analysis to evaluate the efficacy and safety of CNA in this population. PubMed, Embase and Web of Science were searched from January 2005 to August 2025 following PRISMA guidelines. A single-arm proportion meta-analysis was performed using a random effects model. Nineteen observational studies comprising 482 patients with functional bradyarrhythmia who underwent CNA were included (mean age 38.1 ± 5.1 years; 55.7% male). Over a mean follow-up of 16.3 ± 3.6 months, the pooled recurrence rate was 13.1% (95% confidence interval [CI] 9.5% - 17.8%; I² = 0%) and the pooled complication rate was 1.0% (95% CI 0.1% - 9.1%; I² = 0%). Subgroup analyses suggested lower recurrence rates with functional SND (9.7% [6.3%-14.6%]; I² = 0%), biatrial ablation (11.0% [6.7%-17.5%]; I² = 10.7%), and the use of extracardiac noncontact vagal stimulation (ECVS) (8.3% [2.7%-22.9%]; I² = 0%). No significant differences were observed among techniques used to identify ganglionated plexi (p = 0.938). Data synthesis indicated a non-significant trend towards increased heart rate, as well as shorter sinus node recovery time (SNRT) and corrected SNRT after CNA. These findings support that CNA may be effective and safe in functional SND and AVB; however, the overall certainty of evidence is low, and larger, well-designed clinical trials are required to inform future guideline recommendations.