Cardioneural ablation provides a new treatment option for vasovagal syncope
Electrophysiologists are starting to use catheter ablation more and more for an emerging procedure known as cardioneural ablation that can reduce recurrent fainting episodes caused by excessive vagal nerve activity.
Roderick Tung, MD, chief of cardiology with the University of Arizona College of Medicine and director of the Banner Heart Institute, said cardioneural ablation represents a new intersection between cardiology and neurology that targets the autonomic nervous system's influence on the heart.
"People often think of a simple faint as just passing out, but it's actually a brain-heart reflex," Tung explained in an interview with Cardiovascular Business.
Treating difficult cases of vasovagal syncope
The procedure is aimed at patients with recurrent vasovagal syncope, particularly those with malignant vasovagal syncope who experience frequent fainting episodes that can significantly impair their quality of life.
Tung said a typical vasovagal episode begins with a trigger such as fear, excitement or the sight of blood. This causes a surge of adrenaline, and the body's response then overcompensates by activating the vagus nerve, slowing the heart rate and lowering blood pressure enough to cause a loss of consciousness.
Most patients who experience a single fainting episode require no treatment. However, patients who faint repeatedly, sometime even multiple times per day, may require care. So far, their treatment options have been limited to medications and strategies for preventing injuries during their fainting episodes.
Cardioneural ablation provides a new potential treatment option. It involves modifying the nerve signals responsible for slowing of the heart.
Using familiar EP tools for a new purpose
The procedure uses the same EP lab catheter-based technologies and three-dimensional mapping systems routinely employed for conventional electrophysiology ablations. Physicians insert catheters through the femoral vein and deliver radiofrequency energy to specific autonomic nerve clusters, or ganglionated plexi, that regulate a person's heart rate.
Rather than eliminating an arrhythmia, the goal is to blunt excessive parasympathetic input from the vagus nerve, restoring a healthier balance between the sympathetic and parasympathetic nervous systems, Tung explained.
"It's literally hitting a nerve. You can rebalance the wiring of the heart," he said.
He compared the approach to other emerging denervation therapies, including renal denervation for resistant hypertension, but emphasized that cardioneural ablation targets predictable anatomical regions within the heart to achieve more precise autonomic modulation.
Early U.S. experience with cardioneural ablation shows promising results
Tung and a team of researchers published the largest U.S. multicenter experience with the procedure in 2025.[1] The team reported success rates exceeding 80% in patients suffering from recurrent malignant vasovagal syncope, suggesting the technique may provide meaningful symptom relief for a patient population with few effective treatment options.
Unlike traditional catheter ablation procedures used to treat atrial fibrillation or ventricular tachycardia, cardioneural ablation addresses nonarrhythmogenic syncope. While patients experience profound slowing of the heart during episodes, the underlying problem is an exaggerated autonomic reflex rather than an electrical rhythm disorder, Tung explained.
Part of a broader trend
Tung said cardioneural ablation reflects a growing interest in therapies that modulate the autonomic nervous system rather than treating only electrical or structural heart disease. Renal denervation to treat hypertension is already FDA-cleared, and there is now research looking at pulmonary hypertension neurological disorders such as epilepsy.
But for now, cardioneural ablation remains an off-label procedure performed primarily at specialized centers under compassionate use while larger clinical trials are developed.
"We're borrowing all the techniques," Tung said. "It's just for a different indication."
As additional clinical evidence becomes available, he hopes prospective trials will better define which patients benefit most from this therapy.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]