PIRECNA: Cardioneuroablation is feasible for vagally-induced atrioventricular block

The results from the PIRECNA registry showed that cardioneuroablation with or without electrophysiology study is a feasible technique for patients with symptomatic paroxysmal or persistent vagally-induced atrioventricular block.

PIRECNA is a retrospective, international, multicentre registry assessing cardioneuroablation for symptomatic paroxysmal or persistent vagally-induced atrioventricular block [1]. Patients were excluded if presenting with infranodal or nocturnal only atrioventricular block. Included were 130 participants, who underwent pre-procedure atropine testing followed by cardioneuroablation with or without electrophysiology study. The primary endpoint was symptomatic atrioventricular block or syncope recurrence. The results were presented by Dr Henry Huang (Rush University Medical Center, IL, USA).

Of the 130 cardioneuroablation procedures performed, 125 (96.2%) were successful. The median procedure time was 105.5 minutes (range 90–123), and 90% of participants underwent bi-atrial ablation. After a median follow-up of 300 days (range 150–496), 17/125 (14%) met the primary endpoint. In participants with a follow-up of at least 360 days, the primary endpoint was met in 23% of cases. Participants meeting the primary endpoint tended to be older and with higher rates of comorbidities such as hypertension, coronary artery disease, or history of atrial fibrillation. Experienced centres (i.e. >50 prior procedures) showed a non-significant trend for improved outcomes (HR 0.52; 95% CI 0.19–1.41; P=0.19). There was also a trend for fewer total ablation lesions (P=0.002) and longer procedure time (P=0.017) if extracardiac vagal stimulation was used.

Dr Huang summarised that “based on this registry, cardioneuroablation might be feasible to be performed for patients with vagally-mediated atrioventricular block.” However, he stressed that some questions remain, such as the best ablation endpoints as well as how generalisable this technique will be to new centres.

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   1. Huang H, et al. Procedural and Intermediate-term Results of Electroanatomical-guided CardioNeuroablation for treatment of Atrioventricular block: PIRECNA Multicenter Study. Late-Breaking Science: clinical. EHRA Congress 2024, 7–9 April, Berlin, Germany.

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Posted on 29 April 20241 May 2024