Аннотация
Aim: To assess the clinical efficacy and safety of cardioneuroablation (CNA) in patients with vagally-mediated dysfunction of sinus and atrioventricular (AV) nodes. Methods: Between August 2023 and March 2025, 21 CNA procedures were performed in patients with autonomic dysfunction of the sinus node and functional second- and third-degree AV block. Clinical follow-up assessments were conducted at 3, 6, 12, and 24 months post-procedure, including 24-hour Holter monitoring and validated quality-of-life questionnaires. Results: A total of 21 patients (mean age 37.4 ± 10.2 years) were included. CNA resulted in a significant increase in mean heart rate (HR) from 53.2 ± 9.6 beats per minute (bpm) to 70.4 ± 7.8 bpm (mean difference +17.1 bpm; 95% confidence interval [CI]: 13.5-20.8; p < 0.001; Cohen’s d = 2.13). Significant improvement in antegrade AV conduction (Wenckebach point: 541.9 ± 139.9 to 393.8 ± 63.7 ms; p < 0.001; d = 1.34) and corrected sinus node recovery time (cSNRT: 524.5 ± 273.1 to 320.5 ± 76.9 ms; p = 0.030) was observed. PR, AH, and HV intervals showed no significant changes (all p > 0.05). All six patients with prior syncope remained syncope-free throughout follow-up. Statistically significant improvement was observed in all five EQ-5D domains (p ≤ 0.025). Conclusion: In selected patients with confirmed vagally mediated bradyarrhythmias, CNA is a feasible catheter-based procedure that may reduce the need for permanent pacemaker implantation. These preliminary results from a single-center pilot cohort study demonstrate significant improvement in HR, electrophysiological parameters, and health-related quality of life. Confirmation in larger multicenter controlled studies is required before broader clinical implementation.