Catheter Ablation as a Treatment for Vasovagal Syncope: The Time has Come to Shift Towards Placebo-controlled Trials

Abstract

Vasovagal syncope (VVS), a common autonomic disorder, often sees limited effectiveness with conventional treatments. Cardioneuroablation (CNA), which targets the cardiac ganglionated plexi to modulate heart rate and rhythm, has surfaced as a potential alternative. Despite positive outcomes in clinical trials, the integration of CNA into standard clinical guidelines has been impeded by the lack of placebo-controlled randomized controlled trials (RCTs) — the gold standard for the validation of new clinical interventions. This review scrutinizes the various techniques for mapping the ganglionated plexi, crucial for the efficacy of CNA, and calls for the establishment of standardized, multicentre RCTs to confirm CNA's true therapeutic value.