Changes in electrophysiological parameters after cardioneuroablation in different types of conduction disorders in patients with functional bradyarrhythmias

Aim. Cardioneuroablation (CNA) is an emerging therapeutic approach for functional bradyarrhythmias, yet the dynamics of electrophysiological (EP) parameters following the procedure remain insufficiently characterized. Stratifying patients according to the type of conduction disturbance may provide a more precise assessment of procedural outcomes.

Methods. This prospective single-center study included 109 patients (38.2±11.4 years; 61% male) with symptomatic functional bradyarrhythmias who underwent CNA using anatomical and/or electroanatomical mapping-guided strategies. Heart rate (HR), sinus node recovery time (SNRT), corrected SNRT (cSNRT), AH, PQ, and HV intervals, atrioventricular node effective refractory period (ERP AV), and Wenckebach point were measured before and after CNA. Patients were stratified into three groups: sinus node dysfunction (SND, n=46), atrioventricular node dysfunction (AVND, n=41), and combined phenotype (SND+AVND, n=22).

Results. CNA resulted in a significant increase in HR (from 61 [53-70] to 72 [64-80] bpm, p<0.001), reduction of SNRT (from 1375 [1169-1770] to 1190 [1000-1400] ms, p<0.001) and cSNRT (from 367 [258-512] to 280 [209-368] ms, p<0.001), as well as shortening of AH interval (from 108 [86-166] to 96 [84-118] ms, p=0.001) and PQ interval (from 186 [160-220] to 169 [150-200] ms, p<0.001). In the SND group the most pronounced changes were observed in HR and SNRT, while in the AVND group the greatest effect was noted in AH and PQ intervals. The combined phenotype demonstrated mixed effects.

Conclusion. CNA induces significant modifications in EP parameters, reflecting attenuation of vagal influence on the cardiac conduction system. The magnitude and profile of these changes depend on the underlying conduction phenotype, underscoring the importance of personalized stratification in the evaluation of procedural efficacy.

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