russjcardiolРоссийский кардиологический журналRussian Journal of Cardiology1560-40712618-7620«SILICEA-POLIGRAF» LLC10.15829/1560-4071-2024-6206WNTMBArussjcardiol-6206Research ArticleДИССИНХРОНИЯ. РЕСИНХРОНИЗАЦИЯ. СТИМУЛЯЦИЯ. ХРОНИЧЕСКАЯ СЕРДЕЧНАЯ НЕДОСТАТОЧНОСТЬDISSYNCHRONY. RESYNCHRONIZATION. STIMULATION. CHRONIC HEART FAILUREКардионейроаблация в лечении нейрокардиогенных обмороков и функциональных брадиаритмий. Обзор литературыCardioneuroablation in the treatment of neurocardiogenic syncope and functional bradyarrhythmias. A literature reviewhttps://orcid.org/0000-0003-1300-4986ГоревМ. В.GorevM. V.

Горев Максим Васильевич — врач-аритмолог.

Москва

Moscow

drgorevmv@gmail.comhttps://orcid.org/0000-0002-4094-7771РзаевФ. Г.RzaevF. G.

Рзаев Фархад Гусейнович — к. м. н., зав. отделением хирургического лечения сложных нарушений ритма сердца и электрокардиостимуляции; доцент кафедры кардиологии.

Москва

Moscow

frzaev@mail.ruhttps://orcid.org/0000-0002-0200-7674ВахрушевА. Д.VakhrushevA. D.

Вахрушев Александр Дмитриевич — к. м. н., с. н. с. научно-исследовательской лаборатории нейромодуляции научно-исследовательского отдела аритмологии института сердца и сосудов.

Санкт-Петербург

St. Petersburg

advakhrushev@gmail.comhttps://orcid.org/0000-0002-6553-9141МихайловЕ. Н.MikhailovE. N.

Михайлов Евгений Николаевич — д. м. н., профессор, декан факультета послевузовского и дополнительного образования, профессор кафедры сердечно-сосудистой хирургии института медицинского образования, руководитель научно-исследовательской лаборатории нейромодуляции научно-исследовательского отдела аритмологии института сердца и сосудов.

Санкт-Петербург

St. Petersburg

evgenymikhaylov@gmail.comГБУЗ ГКБ № 52 Департамента здравоохранения города МосквыРоссияCity Clinical Hospital № 52Russian FederationГБУЗ ГКБ им. И.В. Давыдовского Департамента здравоохранения города Москвы; ФГБОУ ВО Российский университет медициныРоссияDavydovsky City Clinical Hospital; Russian University of MedicineRussian FederationФГБУ НМИЦ им. В.А. Алмазова Минздрава РоссииРоссияAlmazov National Medical Research CenterRussian Federation202427122024294SОбразование62066206Copyright © Горев М.В., Рзаев Ф.Г., Вахрушев А.Д., Михайлов Е.Н., 20252025Горев М.В., Рзаев Ф.Г., Вахрушев А.Д., Михайлов Е.Н.Gorev M.V., Rzaev F.G., Vakhrushev A.D., Mikhailov E.N.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://russjcardiol.elpub.ru/jour/article/view/6206

Не угасает интерес к автономной нервной регуляции сердечно-сосудистой системы. Изменения активности автономной нервной системы участвуют в патогенезе острых и хронических состояний, таких как синусовая брадикардия, остановка синусового узла и атриовентрикулярная блокада, вазовагальный обморок и другие типы синкопальных состояний. Традиционные способы профилактики и лечения подобных состояний включают изменения образа жизни, фармакотерапию и, в определенных обстоятельствах, имплантацию электрокардиостимулятора, однако во многих случаях они не способны ни устранить симптомы, ни излечить данное заболевание. Мы провели описательный обзор наиболее значимых публикаций, посвященных исследованию эффективности и разработке методики кардионейроаблации у пациентов с вазовагальными обмороками и нейрогенными функциональными брадиаритмиями — дисфункцией синусового узла и нарушениями атриовентрикулярной проводимости. Эта методика позволяет эффективно предупреждать рецидивы нейрокардиогенных обмороков, снижать склонность к функциональным брадиаритмиям за счет устранения патологического парасимпатического тонуса от сердца. Кардионейроаблация позволяет устранить показания для имплантации электрокардиостимулятора или отсрочить ее выполнение.

Interest in the autonomic regulation of the cardiovascular system does not wane. Changes in autonomic nervous system activity are involved in the pathogenesis of acute and chronic conditions, such as sinus bradycardia, sinus arrest and atrioventricular block, vasovagal syncope and other types of syncopal conditions. Traditional methods of prevention and treatment of such conditions include lifestyle changes, pharmacotherapy and, in some cases, pacemaker implantation, but in many cases they are unable to eliminate the symptoms or cure the disease. We conducted a descriptive review of the most significant publications on effectiveness and development of the cardiac neuroablation technique in patients with vasovagal syncope and neurogenic functional bradyarrhythmias — sinus node dysfunction and atrioventricular conduction disorders. This technique allows to effectively prevent neurocardiogenic syncope relapses, reduce the tendency to functional bradyarrhythmias by eliminating pathological parasympathetic tone. Cardioneuroablation allows to eliminate indications for pacemaker implantation or to delay its implementation.

кардионейроаблацияатриовентрикулярная блокаданейрокардиогенный обмороксинкопевазовагальныйдисфункция синусового узлаcardiac neuroablationatrioventricular blockneurocardiogenic syncopesyncopevasovagalsinus node dysfunctionРабота частично выполнена в рамках государственного задания (Регистрационный номер НИОКТР 124021600052-5).The work was partially carried out within the state assignment (Registration number NIOKTR 124021600052-5).ReferencesSoteriades ES, Evans JC, Larson MG, et al. Incidence and Prognosis of Syncope. N Engl J Med. 2002;347:878-85. doi:10.1056/NEJMoa012407.Soteriades ES, Evans JC, Larson MG, et al. Incidence and Prognosis of Syncope. N Engl J Med. 2002;347:878-85. doi:10.1056/NEJMoa012407.Brignole M, Moya A, de Lange FJ, et al. 2018 ESC Guidelines for the diagnosis and management of syncope. Eur Heart J. 2018;39:1883-948. doi:10.1093/eurheartj/ehy037.Brignole M, Moya A, de Lange FJ, et al. 2018 ESC Guidelines for the diagnosis and management of syncope. Eur Heart J. 2018;39:1883-948. doi:10.1093/eurheartj/ehy037.Shen W-K, Sheldon RS, Benditt DG, et al. 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation. 2017;136. doi:10.1161/CIR.0000000000000499.Shen W-K, Sheldon RS, Benditt DG, et al. 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Circulation. 2017;136. doi:10.1161/CIR.0000000000000499.Shields RW. Functional Anatomy of the Autonomic Nervous System. J Clin Neurophysiol. 1993;10:2-13. doi:10.1097/00004691-199301000-00002.Shields RW. Functional Anatomy of the Autonomic Nervous System. J Clin Neurophysiol. 1993;10:2-13. doi:10.1097/00004691-199301000-00002.Goldberger JJ, Arora R, Buckley U, Shivkumar K. Autonomic Nervous System Dysfunction. J Am Coll Cardiol. 2019;73:1189-206. doi:10.1016/j.jacc.2018.12.064.Goldberger JJ, Arora R, Buckley U, Shivkumar K. Autonomic Nervous System Dysfunction. J Am Coll Cardiol. 2019;73:1189-206. doi:10.1016/j.jacc.2018.12.064.Westfall TC. Local regulation of adrenergic neurotransmission. Physiol Rev. 1977;57:659-728. doi:10.1152/physrev.1977.57.4.659.Westfall TC. Local regulation of adrenergic neurotransmission. Physiol Rev. 1977;57:659-728. doi:10.1152/physrev.1977.57.4.659.Smolen AJ. Morphology of synapses in the autonomic nervous system. J Electron Microsc Tech. 1988;10:187-204. doi:10.1002/jemt.1060100205.Smolen AJ. Morphology of synapses in the autonomic nervous system. J Electron Microsc Tech. 1988;10:187-204. doi:10.1002/jemt.1060100205.Ito M, Zipes DP. Efferent sympathetic and vagal innervation of the canine right ventricle. Circulation. 1994;90:1459-68. doi:10.1161/01.CIR.90.3.1459.Ito M, Zipes DP. Efferent sympathetic and vagal innervation of the canine right ventricle. Circulation. 1994;90:1459-68. doi:10.1161/01.CIR.90.3.1459.Crick SJ, Anderson RH, Ho SY, Sheppard MN. Localisation and quantitation of autonomic innervation in the porcine heart II: endocardium, myocardium and epicardium. J Anat. 1999;195:359-73. doi:10.1046/j.1469-7580.1999.19530359.x.Crick SJ, Anderson RH, Ho SY, Sheppard MN. Localisation and quantitation of autonomic innervation in the porcine heart II: endocardium, myocardium and epicardium. J Anat. 1999;195:359-73. doi:10.1046/j.1469-7580.1999.19530359.x.Aksu T, Yalin K, Mutluer FO, et al. The impact of the clinical diagnosis on the vagal response and heart rate after ganglionated plexus ablation. J Interv Card Electrophysiol. 2022. doi:10.1007/s10840-022-01270-5.Aksu T, Yalin K, Mutluer FO, et al. The impact of the clinical diagnosis on the vagal response and heart rate after ganglionated plexus ablation. J Interv Card Electrophysiol. 2022. doi:10.1007/s10840-022-01270-5.Sra JS, Jazayeri MR, Avitall B, et al. Comparison of Cardiac Pacing with Drug Therapy in the Treatment of Neurocardiogenic (Vasovagal) Syncope with Bradycardia or Asystole. N Engl J Med. 1993;328:1085-90. doi:10.1056/NEJM199304153281504.Sra JS, Jazayeri MR, Avitall B, et al. Comparison of Cardiac Pacing with Drug Therapy in the Treatment of Neurocardiogenic (Vasovagal) Syncope with Bradycardia or Asystole. N Engl J Med. 1993;328:1085-90. doi:10.1056/NEJM199304153281504.Romme JJ, Reitsma JB, Black CN, et al. Drugs and pacemakers for vasovagal, carotid sinus and situational syncope. Cochrane Database Syst Rev. 2011;2013. doi:58.CD004194.pub3.Romme JJ, Reitsma JB, Black CN, et al. Drugs and pacemakers for vasovagal, carotid sinus and situational syncope. Cochrane Database Syst Rev. 2011;2013. doi:58.CD004194.pub3.Sridharan A, Bradfield JS, Shivkumar K, Ajijola OA. Autonomic nervous system and arrhythmias in structural heart disease. Auton Neurosci. 2022;243:103037. doi:10.1016/j.autneu.2022.103037.Sridharan A, Bradfield JS, Shivkumar K, Ajijola OA. Autonomic nervous system and arrhythmias in structural heart disease. Auton Neurosci. 2022;243:103037. doi:10.1016/j.autneu.2022.103037.Calvillo L, Vanoli E, Andreoli E, et al. Vagal Stimulation, Through its Nicotinic Action, Limits Infarct Size and the Inflammatory Response to Myocardial Ischemia and Reperfusion. J Cardiovasc Pharmacol. 2011;58:500-7. doi:10.1097/FJC.0b013e31822b7204.Calvillo L, Vanoli E, Andreoli E, et al. Vagal Stimulation, Through its Nicotinic Action, Limits Infarct Size and the Inflammatory Response to Myocardial Ischemia and Reperfusion. J Cardiovasc Pharmacol. 2011;58:500-7. doi:10.1097/FJC.0b013e31822b7204.Pachon JC, Pachon EI, Cunha Pachon MZ, et al. Catheter ablation of severe neurally meditated reflex (neurocardiogenic or vasovagal) syncope: cardioneuroablation long-term results. Europace. 2011;13:1231-42. doi:10.1093/europace/eur163.Pachon JC, Pachon EI, Cunha Pachon MZ, et al. Catheter ablation of severe neurally meditated reflex (neurocardiogenic or vasovagal) syncope: cardioneuroablation long-term results. Europace. 2011;13:1231-42. doi:10.1093/europace/eur163.Pachon M EI, Pachon-Mateos JC, Higuti C, et al. Relation of Fractionated Atrial Potentials With the Vagal Innervation Evaluated by Extracardiac Vagal Stimulation During Cardioneuroablation. Circ Arrhythmia Electrophysiol. 2020;13. doi:10.1161/CIRCEP.119.007900.Pachon M EI, Pachon-Mateos JC, Higuti C, et al. Relation of Fractionated Atrial Potentials With the Vagal Innervation Evaluated by Extracardiac Vagal Stimulation During Cardioneuroablation. Circ Arrhythmia Electrophysiol. 2020;13. doi:10.1161/CIRCEP.119.007900.Aksu T, Golcuk E, Yalin K, et al. Simplified Cardioneuroablation in the Treatment of Reflex Syncope, Functional AV Block, and Sinus Node Dysfunction. Pacing Clin Electrophysiol. 2016;39:42-53. doi:10.1111/pace.12756.Aksu T, Golcuk E, Yalin K, et al. Simplified Cardioneuroablation in the Treatment of Reflex Syncope, Functional AV Block, and Sinus Node Dysfunction. Pacing Clin Electrophysiol. 2016;39:42-53. doi:10.1111/pace.12756.Aksu T, Padmanabhan D, Shenthar J, et al. The benefit of cardioneuroablation to reduce syncope recurrence in vasovagal syncope patients: a case-control study. J Interv Card Electrophysiol. 2022;63:77-86. doi:10.1007/s10840-020-00938-0.Aksu T, Padmanabhan D, Shenthar J, et al. The benefit of cardioneuroablation to reduce syncope recurrence in vasovagal syncope patients: a case-control study. J Interv Card Electrophysiol. 2022;63:77-86. doi:10.1007/s10840-020-00938-0.Aksu T, Guler TE, Bozyel S, Yalin K. Selective vagal innervation principles of ganglionated plexi: step-by-step cardioneuroablation in a patient with vasovagal syncope. J Interv Card Electrophysiol. 2021;60:453-8. doi:10.1007/s10840-020-00757-3.Aksu T, Guler TE, Bozyel S, Yalin K. Selective vagal innervation principles of ganglionated plexi: step-by-step cardioneuroablation in a patient with vasovagal syncope. J Interv Card Electrophysiol. 2021;60:453-8. doi:10.1007/s10840-020-00757-3.Aksu T, Gopinathannair R, Bozyel S, et al. Cardioneuroablation for Treatment of Atrioventricular Block. Circ Arrhythmia Electrophysiol. 2021;14:E010018. doi:10.1161/CIRCEP.121.010018.Aksu T, Gopinathannair R, Bozyel S, et al. Cardioneuroablation for Treatment of Atrioventricular Block. Circ Arrhythmia Electrophysiol. 2021;14:E010018. doi:10.1161/CIRCEP.121.010018.Linz D, Stavrakis S. Cardioneuroablation for vasovagal syncope: How to move beyond "learning by burning"? J Interv Card Electrophysiol. 2022. doi:10.1007/s10840-022-01232-x.Linz D, Stavrakis S. Cardioneuroablation for vasovagal syncope: How to move beyond "learning by burning"? J Interv Card Electrophysiol. 2022. doi:10.1007/s10840-022-01232-x.Aksu T, Gopinathannair R, Gupta D, Pauza DH. Intrinsic cardiac autonomic nervous system: What do clinical electrophysiologists need to know about the "heart brain"? J Cardiovasc Electrophysiol. 2021;32:1737-47. doi:10.1111/jce.15058.Aksu T, Gopinathannair R, Gupta D, Pauza DH. Intrinsic cardiac autonomic nervous system: What do clinical electrophysiologists need to know about the "heart brain"? J Cardiovasc Electrophysiol. 2021;32:1737-47. doi:10.1111/jce.15058.Levy MN. Brief Reviews. Circ Res. 1971;29:437-45. doi:10.1161/01.RES.29.5.437.Levy MN. Brief Reviews. Circ Res. 1971;29:437-45. doi:10.1161/01.RES.29.5.437.Levy MN, Zieske H. Autonomic control of cardiac pacemaker activity and atrioventricular transmission. J Appl Physiol. 1969;27:465-70. doi:10.1152/jappl.1969.27.4.465.Levy MN, Zieske H. Autonomic control of cardiac pacemaker activity and atrioventricular transmission. J Appl Physiol. 1969;27:465-70. doi:10.1152/jappl.1969.27.4.465.Armour JA. Potential clinical relevance of the ‘little brain' on the mammalian heart. Exp Physiol. 2008;93:165-76. doi:10.1113/expphysiol.2007.041178.Armour JA. Potential clinical relevance of the ‘little brain' on the mammalian heart. Exp Physiol. 2008;93:165-76. doi:10.1113/expphysiol.2007.041178.Fedele L, Brand T. The Intrinsic Cardiac Nervous System and Its Role in Cardiac Pacemaking and Conduction. J Cardiovasc Dev Dis. 2020;7:54. doi:10.3390/jcdd7040054.Fedele L, Brand T. The Intrinsic Cardiac Nervous System and Its Role in Cardiac Pacemaking and Conduction. J Cardiovasc Dev Dis. 2020;7:54. doi:10.3390/jcdd7040054.Fernholm M. On the development of the sympathetic chain and the adrenal medulla in the mouse. Zeitschrift for Anat und Entwicklungsgeschichte. 1971;133:305-17. doi:10.1007/BF00519305.Fernholm M. On the development of the sympathetic chain and the adrenal medulla in the mouse. Zeitschrift for Anat und Entwicklungsgeschichte. 1971;133:305-17. doi:10.1007/BF00519305.Becker RF, Grunt JA. The cervical sympathetic ganglia. Anat Rec. 1957;127:1-14. doi:10.1002/ar.1091270102.Becker RF, Grunt JA. The cervical sympathetic ganglia. Anat Rec. 1957;127:1-14. doi:10.1002/ar.1091270102.Kawashima T. The autonomic nervous system of the human heart with special reference to its origin, course, and peripheral distribution. Anat Embryol (Berl). 2005;209:425-38. doi:10.1007/s00429-005-0462-1.Kawashima T. The autonomic nervous system of the human heart with special reference to its origin, course, and peripheral distribution. Anat Embryol (Berl). 2005;209:425-38. doi:10.1007/s00429-005-0462-1.Ellison JP, Williams TH. Sympathetic nerve pathways to the human heart, and their variations. Am J Anat. 1969;124:149-62. doi:10.1002/aja.1001240203.Ellison JP, Williams TH. Sympathetic nerve pathways to the human heart, and their variations. Am J Anat. 1969;124:149-62. doi:10.1002/aja.1001240203.Manolis AA, Manolis TA, Apostolopoulos EJ, et al. The role of the autonomic nervous system in cardiac arrhythmias: The neuro-cardiac axis, more foe than friend? Trends Cardiovasc Med. 2021;31:290-302. doi:10.1016/j.tcm.2020.04.011.Manolis AA, Manolis TA, Apostolopoulos EJ, et al. The role of the autonomic nervous system in cardiac arrhythmias: The neuro-cardiac axis, more foe than friend? Trends Cardiovasc Med. 2021;31:290-302. doi:10.1016/j.tcm.2020.04.011.Lee S, Wellens HJJ, Josephson ME. Paroxysmal atrioventricular block. Heart Rhythm. 2009;6:1229-34. doi:10.1016/j.hrthm.2009.04.001.Lee S, Wellens HJJ, Josephson ME. Paroxysmal atrioventricular block. Heart Rhythm. 2009;6:1229-34. doi:10.1016/j.hrthm.2009.04.001.Guo YP, McLeod JG, Baverstock J. Pathological changes in the vagus nerve in diabetes and chronic alcoholism. J Neurol Neurosurg; Psychiatry. 1987;50:1449-53. doi:10.1136/jnnp.50.11.1449.Guo YP, McLeod JG, Baverstock J. Pathological changes in the vagus nerve in diabetes and chronic alcoholism. J Neurol Neurosurg; Psychiatry. 1987;50:1449-53. doi:10.1136/jnnp.50.11.1449.Chen P-S, Chen LS, Fishbein MC, et al. Role of the Autonomic Nervous System in Atrial Fibrillation. Circ Res. 2014;114:1500-15. doi:10.1161/CIRCRESAHA.114.303772.Chen P-S, Chen LS, Fishbein MC, et al. Role of the Autonomic Nervous System in Atrial Fibrillation. Circ Res. 2014;114:1500-15. doi:10.1161/CIRCRESAHA.114.303772.Schauerte P, Scherlag BJ, Patterson E, et al. Focal Atrial Fibrillation: Experimental Evidence for a Pathophysiologic Role of the Autonomic Nervous System. J Cardiovasc Electrophysiol. 2001;12:592-9. doi:10.1046/j.1540-8167.2001.00592.x.Schauerte P, Scherlag BJ, Patterson E, et al. Focal Atrial Fibrillation: Experimental Evidence for a Pathophysiologic Role of the Autonomic Nervous System. J Cardiovasc Electrophysiol. 2001;12:592-9. doi:10.1046/j.1540-8167.2001.00592.x.Vakhrushev AD, Condori Leandro EI, Korobchenko LE, et al. Laser catheter ablation of atrial zones with ganglionated plexi: impact on atrial fibrillation inducibility and the risk of esophageal damage in experimental settings. J Arrhythmology. 2024;31:44-53. doi:10.35336/VA-1209.Vakhrushev AD, Condori Leandro EI, Korobchenko LE, et al. Laser catheter ablation of atrial zones with ganglionated plexi: impact on atrial fibrillation inducibility and the risk of esophageal damage in experimental settings. J Arrhythmology. 2024;31:44-53. doi:10.35336/VA-1209.Rachkova II, Sergeeva OA, Gorev MV, et al. Additional left atrial lesions improve the effect of cryoballoon pulmonary vein isolation in paroxysmal atrial fibrillation patients. J Arrhythmology. 2023;30:27-34. doi:10.35336/VA-2023-2-04.Rachkova II, Sergeeva OA, Gorev MV, et al. Additional left atrial lesions improve the effect of cryoballoon pulmonary vein isolation in paroxysmal atrial fibrillation patients. J Arrhythmology. 2023;30:27-34. doi:10.35336/VA-2023-2-04.Pauza DH, Skripka V, Pauziene N, Stropus R. Morphology, distribution, and variability of the epicardiac neural ganglionated subplexuses in the human heart. Anat Rec. 2000;259: 353-82. doi:10.1002/1097-0185(20000801)259:4%3C353::AID-AR10%3E3.0.CO;2-R.Pauza DH, Skripka V, Pauziene N, Stropus R. Morphology, distribution, and variability of the epicardiac neural ganglionated subplexuses in the human heart. Anat Rec. 2000;259: 353-82. doi:10.1002/1097-0185(20000801)259:4%3C353::AID-AR10%3E3.0.CO;2-R.Armour JA, Murphy DA, Yuan B-X, et al. Gross and microscopic anatomy of the human intrinsic cardiac nervous system. Anat Rec. 1997;247:289-98. doi:10.1002/(SICI)1097-0185(199702)247:2%3C289::AID-AR15%3E3.0.CO;2-L.Armour JA, Murphy DA, Yuan B-X, et al. Gross and microscopic anatomy of the human intrinsic cardiac nervous system. Anat Rec. 1997;247:289-98. doi:10.1002/(SICI)1097-0185(199702)247:2%3C289::AID-AR15%3E3.0.CO;2-L.Nakagawa H, Scherlag BJ, Patterson E, et al. Pathophysiologic basis of autonomic ganglionated plexus ablation in patients with atrial fibrillation. Heart Rhythm. 2009;6:S26-34. doi:10.1016/j.hrthm.2009.07.029.Nakagawa H, Scherlag BJ, Patterson E, et al. Pathophysiologic basis of autonomic ganglionated plexus ablation in patients with atrial fibrillation. Heart Rhythm. 2009;6:S26-34. doi:10.1016/j.hrthm.2009.07.029.Ulphani JS, Arora R, Cain JH, et al. The ligament of Marshall as a parasympathetic conduit. Am J Physiol Circ Physiol. 2007;293:H1629-35. doi:10.1152/ajpheart.00139.2007.Ulphani JS, Arora R, Cain JH, et al. The ligament of Marshall as a parasympathetic conduit. Am J Physiol Circ Physiol. 2007;293:H1629-35. doi:10.1152/ajpheart.00139.2007.Shen W-K, Sheldon RS, Benditt DG, et al. 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope. J Am Coll Cardiol. 2017;70:e39-110. doi:10.1016/j.jacc.2017.03.003.Shen W-K, Sheldon RS, Benditt DG, et al. 2017 ACC/AHA/HRS Guideline for the Evaluation and Management of Patients With Syncope. J Am Coll Cardiol. 2017;70:e39-110. doi:10.1016/j.jacc.2017.03.003.Ganzeboom KS, Mairuhu G, Reitsma JB, et al. Lifetime Cumulative Incidence of Syncope in the General Population: A Study of 549 Dutch Subjects Aged 35-60 Years. J Cardiovasc Electrophysiol. 2006;17:1172-6. doi:10.1111/j.1540-8167.2006.00595.x.Ganzeboom KS, Mairuhu G, Reitsma JB, et al. Lifetime Cumulative Incidence of Syncope in the General Population: A Study of 549 Dutch Subjects Aged 35-60 Years. J Cardiovasc Electrophysiol. 2006;17:1172-6. doi:10.1111/j.1540-8167.2006.00595.x.Sheldon RS, Grubb BP, Olshansky B, et al. 2015 Heart Rhythm Society Expert Consensus Statement on the Diagnosis and Treatment of Postural Tachycardia Syndrome, Inappropriate Sinus Tachycardia, and Vasovagal Syncope. Heart Rhythm. 2015;12:e41-63. doi:10.1016/j.hrthm.2015.03.029.Sheldon RS, Grubb BP, Olshansky B, et al. 2015 Heart Rhythm Society Expert Consensus Statement on the Diagnosis and Treatment of Postural Tachycardia Syndrome, Inappropriate Sinus Tachycardia, and Vasovagal Syncope. Heart Rhythm. 2015;12:e41-63. doi:10.1016/j.hrthm.2015.03.029.Jardine DL. Vasovagal Syncope. Cardiol Clin. 2013;31:75-87. doi:10.1016/j.ccl.2012.10.010.Jardine DL. Vasovagal Syncope. Cardiol Clin. 2013;31:75-87. doi:10.1016/j.ccl.2012.10.010.Pachon JC, Pachon EI, Pachon JC, et al. "Cardioneuroablation" — new treatment for neurocardiogenic syncope, functional AV block and sinus dysfunction using catheter RF-ablation. EP Eur. 2005;7:1-13. doi:10.1016/j.eupc.2004.10.003.Pachon JC, Pachon EI, Pachon JC, et al. "Cardioneuroablation" — new treatment for neurocardiogenic syncope, functional AV block and sinus dysfunction using catheter RF-ablation. EP Eur. 2005;7:1-13. doi:10.1016/j.eupc.2004.10.003.Baysal E, Mutluer FO, Dagsali AE, et al. Improved health-related quality of life after cardioneuroablation in patients with vasovagal syncope. J Interv Card Electrophysiol. 2022. doi:10.1007/s10840-022-01420-9.Baysal E, Mutluer FO, Dagsali AE, et al. Improved health-related quality of life after cardioneuroablation in patients with vasovagal syncope. J Interv Card Electrophysiol. 2022. doi:10.1007/s10840-022-01420-9.Aksu T, De Potter T, John L, et al. Procedural and short‐term results of electroanatomic‐ mapping‐guided ganglionated plexus ablation by first‐time operators: A multicenter study. J Cardiovasc Electrophysiol. 2022;33:117-22. doi:10.1111/jce.15278.Aksu T, De Potter T, John L, et al. Procedural and short‐term results of electroanatomic‐ mapping‐guided ganglionated plexus ablation by first‐time operators: A multicenter study. J Cardiovasc Electrophysiol. 2022;33:117-22. doi:10.1111/jce.15278.Gopinathannair R, Olshansky B, Turagam MK, et al. Permanent pacing versus cardioneuroablation for cardioinhibitory vasovagal syncope. J Interv Card Electrophysiol. 2022. doi:10.1007/s10840-022-01456-x.Gopinathannair R, Olshansky B, Turagam MK, et al. Permanent pacing versus cardioneuroablation for cardioinhibitory vasovagal syncope. J Interv Card Electrophysiol. 2022. doi:10.1007/s10840-022-01456-x.Prata A, Katsuyama E, Scardini P, et al. Cardioneuroablation in patients with vasovagal syncope: An updated systematic review and meta-analysis. Heart Rhythm. 2024. doi:10.1016/j.hrthm.2024.07.103.Prata A, Katsuyama E, Scardini P, et al. Cardioneuroablation in patients with vasovagal syncope: An updated systematic review and meta-analysis. Heart Rhythm. 2024. doi:10.1016/j.hrthm.2024.07.103.Aksu T, Chung MK. Cardioneuroablation for Cardioinhibitory Vasovagal Syncope: Rationale, Approaches, and Its Role in Long-Term Management. Curr Cardiovasc Risk Rep. 2024;18:55-64. doi:10.1007/s12170-024-00736-7.Aksu T, Chung MK. Cardioneuroablation for Cardioinhibitory Vasovagal Syncope: Rationale, Approaches, and Its Role in Long-Term Management. Curr Cardiovasc Risk Rep. 2024;18:55-64. doi:10.1007/s12170-024-00736-7.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. doi:10.1007/s10840-024-01789-9.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. doi:10.1007/s10840-024-01789-9.Baskovski E, Ates B, Altin T, Akyurek O. Cardioneuroablation for carotid sinus syndrome mediated by complete atrioventricular block. J Arrhythmia. 2023;39:810-2. doi:10.1002/joa3.12915.Baskovski E, Ates B, Altin T, Akyurek O. Cardioneuroablation for carotid sinus syndrome mediated by complete atrioventricular block. J Arrhythmia. 2023;39:810-2. doi:10.1002/joa3.12915.Palamà Z, Ruvo E De, Grieco D, et al. Carotid sinus hypersensitivity syncope: is there a possible alternative approach to pacemaker implantation in young patients? Adv Interv Cardiol. 2017;2:184-5. doi:10.5114/pwki.2017.67993.Palamà Z, Ruvo E De, Grieco D, et al. Carotid sinus hypersensitivity syncope: is there a possible alternative approach to pacemaker implantation in young patients? Adv Interv Cardiol. 2017;2:184-5. doi:10.5114/pwki.2017.67993.Zerpa Acosta JC, Oliveira de Souza K, Ortencio FA, et al. Carotid sinus syndrome treated by cardioneuroablation: Is sinus node denervation enough? Insights from a syncope recurrence report. Heart Rhythm Case Reports. 2023;9:48-52. doi:10.1016/j.hrcr.2022.10.015.Zerpa Acosta JC, Oliveira de Souza K, Ortencio FA, et al. Carotid sinus syndrome treated by cardioneuroablation: Is sinus node denervation enough? Insights from a syncope recurrence report. Heart Rhythm Case Reports. 2023;9:48-52. doi:10.1016/j.hrcr.2022.10.015.Kusumoto FM, Schoenfeld MH, Barrett C, et al. 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay: Executive summary. Heart Rhythm. 2019;16:e227-79. doi:10.1016/j.hrthm.2018.10.036.Kusumoto FM, Schoenfeld MH, Barrett C, et al. 2018 ACC/AHA/HRS guideline on the evaluation and management of patients with bradycardia and cardiac conduction delay: Executive summary. Heart Rhythm. 2019;16:e227-79. doi:10.1016/j.hrthm.2018.10.036.2021 Рекомендации ESC по электрокардиостимуляции и сердечной ресинхронизирующей терапии. Российский кардиологический журнал. 2022;27(7):5159. doi:10.15829/1560-4071-2022-5159.2021 ESC Guidelines on cardiac pacing and cardiac resynchronization therapy. Russian Journal of Cardiology. 2022;27(7):5159. (In Russ.) doi:10.15829/1560-4071-2022-5159.Ardell JL, Randall WC. Selective vagal innervation of sinoatrial and atrioventricular nodes in canine heart. Am J Physiol. 1986;251:H764-73. doi:10.1152/ajpheart.1986.251.4.H764.Ardell JL, Randall WC. Selective vagal innervation of sinoatrial and atrioventricular nodes in canine heart. Am J Physiol. 1986;251:H764-73. doi:10.1152/ajpheart.1986.251.4.H764.Aksu T, Mutluer FO, Huang H. Cardioneuroablation for the treatment of vasovagal syncope and sinus bradycardia with atrial escape. J Interv Card Electrophysiol. 2022. doi:10.1007/s10840-022-01198-w.Aksu T, Mutluer FO, Huang H. Cardioneuroablation for the treatment of vasovagal syncope and sinus bradycardia with atrial escape. J Interv Card Electrophysiol. 2022. doi:10.1007/s10840-022-01198-w.Zhao L, Jiang W, Zhou L, et al. Atrial autonomic denervation for the treatment of long-standing symptomatic sinus bradycardia in non-elderly patients. J Interv Card Electrophysiol. 2015;43:151-9. doi:10.1007/s10840-015-9981-8.Zhao L, Jiang W, Zhou L, et al. Atrial autonomic denervation for the treatment of long-standing symptomatic sinus bradycardia in non-elderly patients. J Interv Card Electrophysiol. 2015;43:151-9. doi:10.1007/s10840-015-9981-8.Qin M, Zhang Y, Liu X, et al. Atrial Ganglionated Plexus Modification. JACC Clin Electrophysiol. 2017;3:950-9. doi:10.1016/j.jacep.2017.01.022.Qin M, Zhang Y, Liu X, et al. Atrial Ganglionated Plexus Modification. JACC Clin Electrophysiol. 2017;3:950-9. doi:10.1016/j.jacep.2017.01.022.Song Z-L, Qin M, Liu X. Cardioneuroablation for the treatment of symptomatic bradycardia mediated by the cardiac autonomic nervous. J Geriatr Cardiol. 2023;20:615-7. doi:10.26599/1671-5411.2023.09.001.Song Z-L, Qin M, Liu X. Cardioneuroablation for the treatment of symptomatic bradycardia mediated by the cardiac autonomic nervous. J Geriatr Cardiol. 2023;20:615-7. doi:10.26599/1671-5411.2023.09.001.Chen W, Liu Z, Xiao P, et al. Extracardiac Vagal Stimulation-Assisted Cardioneuroablation: Dynamically Evaluating the Impact of Sequential Ganglionated Plexus Ablation on Vagal Control of SAN and AVN in Patients with Sinoatrial Node Dysfunction. J Cardiovasc Dev Dis. 2022;9:188. doi:10.3390/jcdd9060188.Chen W, Liu Z, Xiao P, et al. Extracardiac Vagal Stimulation-Assisted Cardioneuroablation: Dynamically Evaluating the Impact of Sequential Ganglionated Plexus Ablation on Vagal Control of SAN and AVN in Patients with Sinoatrial Node Dysfunction. J Cardiovasc Dev Dis. 2022;9:188. doi:10.3390/jcdd9060188.Kashou AH, Goyal A, Nguyen T, et al. Atrioventricular Block. StatPearls. 2024.Kashou AH, Goyal A, Nguyen T, et al. Atrioventricular Block. StatPearls. 2024.Орлов В. Н., Орлов М. В. Руководство по электрокардиографии. 11-е изд., перераб. и доп. Москва: ООО "Издательство "Медицинское информационное агентство", 2023. 760 с. ISBN 978-5-9986-0506-2.Orlov VN, Orlov MV. Electrocardiography Guidelines. 11th, add. ed. Moscow: МIА; 2023. p. 760. (In Russ.) ISBN 978-5-9986-0506-2.Alboni P, Holz A, Brignole M. Vagally mediated atrioventricular block: pathophysiology and diagnosis. Heart. 2013;99:904-8. doi:10.1136/heartjnl-2012-303220.Alboni P, Holz A, Brignole M. Vagally mediated atrioventricular block: pathophysiology and diagnosis. Heart. 2013;99:904-8. doi:10.1136/heartjnl-2012-303220.Pachonn JC, Pachon EI, Lobo TJ, et al. Syncopal High‐Degree AV Block Treated with Catheter RF Ablation without Pacemaker Implantation. Pacing Clin Electrophysiol. 2006;29:318-22. doi:10.1111/j.1540-8159.2006.00340.x.Pachonn JC, Pachon EI, Lobo TJ, et al. Syncopal High‐Degree AV Block Treated with Catheter RF Ablation without Pacemaker Implantation. Pacing Clin Electrophysiol. 2006;29:318-22. doi:10.1111/j.1540-8159.2006.00340.x.Randall WC, Ardell JL, Wurster RD, Milosavljevic M. Vagal postganglionic innervation of the canine sinoatrial node. J Auton Nerv Syst. 1987;20:13-23. doi:10.1016/0165-1838(87)90077-4.Randall WC, Ardell JL, Wurster RD, Milosavljevic M. Vagal postganglionic innervation of the canine sinoatrial node. J Auton Nerv Syst. 1987;20:13-23. doi:10.1016/0165-1838(87)90077-4.Aksu T, Piotrowski R, Tung R, et al. Procedural and Intermediate-term Results of the Electroanatomical-guided Cardioneuroablation for the Treatment of Supra-Hisian Second- or Advanced-degree Atrioventricular Block: the PIRECNA multicentre registry. Europace. 2024;26. doi:10.1093/europace/euae164/7702740.Aksu T, Piotrowski R, Tung R, et al. Procedural and Intermediate-term Results of the Electroanatomical-guided Cardioneuroablation for the Treatment of Supra-Hisian Second- or Advanced-degree Atrioventricular Block: the PIRECNA multicentre registry. Europace. 2024;26. doi:10.1093/europace/euae164/7702740.Virag N, Erickson M, Taraborrelli P, et al. Predicting vasovagal syncope from heart rate and blood pressure: A prospective study in 140 subjects. Heart Rhythm. 2018;15:1404-10. doi:10.1016/j.hrthm.2018.04.032.Virag N, Erickson M, Taraborrelli P, et al. Predicting vasovagal syncope from heart rate and blood pressure: A prospective study in 140 subjects. Heart Rhythm. 2018;15:1404-10. doi:10.1016/j.hrthm.2018.04.032.Aksu T, Guler TE. Cardioneuroablation in the Management of Vasovagal Syncope, Sinus Node Dysfunction and Functional Atrioventricular Block: Patient Selection Based on Supporting Evidence. J Atr Fibrillation. 2019;13. doi:10.4022/jafib.2396.Aksu T, Guler TE. Cardioneuroablation in the Management of Vasovagal Syncope, Sinus Node Dysfunction and Functional Atrioventricular Block: Patient Selection Based on Supporting Evidence. J Atr Fibrillation. 2019;13. doi:10.4022/jafib.2396.Joza J, Gustavo Bravosi da Rosa L, Alturki A, et al. Cardioneuroablation as a strategy to prevent pacemaker implantation in young patients with vasovagal syncope. IJC Hear Vasc. 2024;51:101360. doi:10.1016/j.ijcha.2024.101360.Joza J, Gustavo Bravosi da Rosa L, Alturki A, et al. Cardioneuroablation as a strategy to prevent pacemaker implantation in young patients with vasovagal syncope. IJC Hear Vasc. 2024;51:101360. doi:10.1016/j.ijcha.2024.101360.Piotrowski R, Baran J, Sikorska A, et al. Cardioneuroablation: comparison of acute effects of the right vs. left atrial approach in patients with reflex syncope: the ROMAN2 study. Europace. 2024;26. doi:10.1093/europace/euae042/7601242.Piotrowski R, Baran J, Sikorska A, et al. Cardioneuroablation: comparison of acute effects of the right vs. left atrial approach in patients with reflex syncope: the ROMAN2 study. Europace. 2024;26. doi:10.1093/europace/euae042/7601242.John L, Mullis A, Payne J, et al. Fractionation Mapping of the Ganglionated Plexi for Cardioneuroablation. J Innov Card Rhythm Manag. 2021;12:4473-6. doi:10.19102/icrm.2021.120405.John L, Mullis A, Payne J, et al. Fractionation Mapping of the Ganglionated Plexi for Cardioneuroablation. J Innov Card Rhythm Manag. 2021;12:4473-6. doi:10.19102/icrm.2021.120405.Aksu T, Guler TE, Mutluer FO, et al. Electroanatomic-mapping-guided cardioneuroablation versus combined approach for vasovagal syncope: a cross-sectional observational study. J Interv Card Electrophysiol. 2019;54:177-88. doi:10.1007/s10840-018-0421-4.Aksu T, Guler TE, Mutluer FO, et al. Electroanatomic-mapping-guided cardioneuroablation versus combined approach for vasovagal syncope: a cross-sectional observational study. J Interv Card Electrophysiol. 2019;54:177-88. doi:10.1007/s10840-018-0421-4.Güler TE, Aksu T. Long-term Efficacy and Safety of Cardioneuroablation in Patients with Vagally Mediated Bradyarrhythmias. e-Journal Cardiovasc Med. 2020;8:28-34. doi:10.32596/ejcm.galenos.2020.02.07.Güler TE, Aksu T. Long-term Efficacy and Safety of Cardioneuroablation in Patients with Vagally Mediated Bradyarrhythmias. e-Journal Cardiovasc Med. 2020;8:28-34. doi:10.32596/ejcm.galenos.2020.02.07.Ben-Haim S, Menichetti F, Roth N, et al. Localization of ganglionated plexi in patients with cardiac arrhythmia — A new application for 123I-mIBG SPECT. J Nucl Med. 2014;55:184.Ben-Haim S, Menichetti F, Roth N, et al. Localization of ganglionated plexi in patients with cardiac arrhythmia — A new application for 123I-mIBG SPECT. J Nucl Med. 2014;55:184.Stirrup J, Gregg S, Baavour R, et al. Hybrid solid-state SPECT/CT left atrial innervation imaging for identification of left atrial ganglionated plexi: Technique and validation in patients with atrial fibrillation. J Nucl Cardiol J. 2020;27:1939-50. doi:10.1007/s12350-018-01535-5.Stirrup J, Gregg S, Baavour R, et al. Hybrid solid-state SPECT/CT left atrial innervation imaging for identification of left atrial ganglionated plexi: Technique and validation in patients with atrial fibrillation. J Nucl Cardiol J. 2020;27:1939-50. doi:10.1007/s12350-018-01535-5.Markman TM, Khoshknab M, Santangeli P, et al. Feasibility of Computed Tomography-Guided Cardioneuroablation for Atrial Fibrillation. JACC Clin Electrophysiol [Internet]. 2022;8:1449-50. doi:10.1016/j.jacep.2022.06.004.Markman TM, Khoshknab M, Santangeli P, et al. Feasibility of Computed Tomography-Guided Cardioneuroablation for Atrial Fibrillation. JACC Clin Electrophysiol [Internet]. 2022;8:1449-50. doi:10.1016/j.jacep.2022.06.004.Stavrakis S, Po S. Ganglionated Plexi Ablation: Physiology and Clinical Applications. Arrhythmia Electrophysiol Rev. 2017;6:186. doi:10.15420/aer2017.26.1.Stavrakis S, Po S. Ganglionated Plexi Ablation: Physiology and Clinical Applications. Arrhythmia Electrophysiol Rev. 2017;6:186. doi:10.15420/aer2017.26.1.Gorev MV, Nardaia SG, Petelko SV, et al. Baroreflex activity change after pulmonary vein isolation in patients with atrial fibrillation. J Arrhythmology. 2023;30:44-50. doi:10.35336/VA-2023-2-06.Gorev MV, Nardaia SG, Petelko SV, et al. Baroreflex activity change after pulmonary vein isolation in patients with atrial fibrillation. J Arrhythmology. 2023;30:44-50. doi:10.35336/VA-2023-2-06.

The authors declare that there are no conflicts of interest present.