Cardioneural Ablation: A New Solution for Patients with Stubborn Fainting.

In the movies, fainting can be a dramatic swoon and an important plot point. In real life, the consequences can be much more serious, including injury, trauma, and a trip to the emergency room.

For patients with stubborn fainting, known as refractory vasovagal syncope (VVS), repeated episodes of losing consciousness can lead to anxiety, difficulty leaving the house, and a lower quality of life. 

VVS is the most common form of fainting, in which the body’s natural reflexes overreact to a trigger, such as seeing blood, causing a sudden, temporary loss of consciousness. About one third of people will have at least one episode of syncope in their lifetime, most due to VVS.

While not all fainting episodes can be prevented, VVS often can be managed by increasing fluid and salt intake, avoiding triggers, and performing physical counter maneuvers such as tightening one’s arm muscles. In some cases, taking medication or getting a pacemaker to control heart rhythms can help. 

But for patients who need a more targeted approach, an exciting new procedure available at MedStar Health is helping people with VVS get their lives back. 

Cardioneural ablation (CNA) is a sophisticated, minimally invasive procedure in which a cardiac electrophysiologist adjusts the patient’s cardiac autonomic nervous system, which controls essential functions such as breathing, digestion, and the heartbeat.

What causes the body to overreact?

The body’s most crucial operations are controlled by the autonomic nervous system (ANS), which has two main systems:

• Sympathetic: The gas pedal, this system controls the “fight or flight” response

• Parasympathetic: The brake pedal, which controls “rest and digest” functions

In a healthy person, these systems work together in balance. They regulate how fast the heart beats based on activity levels.

For people who have VVS, the parasympathetic system is super sensitive, especially the vagus nerve. This nerve acts like an aggressive brake pedal, suddenly instructing the heart to slow down and the blood vessels to relax all at once. This overreaction causes the body to short circuit, and fainting results.

These signals move through tiny clusters of nerve endings on the heart known as ganglionated plexi (GPs). When they’re hyperactive, too, the vagus nerve’s panic signal gets amplified, making VVS worse.

With cardioneural ablation, we can gently modify and decrase the effect of these hyperactive nerve clusters, restoring balance to the ANS, preventing overreaction and fainting.

Related reading: Fainting at the Sight of Blood? It Could Be Vasovagal Syncope.

How does cardioneural ablation work?

In this procedure, the doctor guides thin, flexible tubes (catheters) through a vein in the leg until they reach the heart. Using advanced imaging technology to create a 3D map of the heart’s electrical system, the doctor locates the GPs on the heart’s surface. We use precise radiofrequency energy to selectively ablate and deactivate specific GP nerves, recalibrating the heart’s autopilot and relieving VVS symptoms.

Using a minimally invasive approach means patients have shorter recovery times, with less pain and fewer complications than traditional open surgery. 

Cardioneural ablation is not yet considered the standard of care. However, positive results from clinical studies suggest CNA could be an effective treatment for many people with drug-refractory VVS. The largest study to date examined the outcomes of 205 patients across the nation who underwent CNA. At an average of 14 months after the procedure, 78% of patients hadn’t experienced another fainting episode, and 97% avoided the need for a pacemaker. 

Researchers noted these patients achieved faster baseline heart rate and a low rate of complications. These findings support earlier research—one analysis of 14 of studies reported that almost 92% of patients with VVS were fainting-free after CNA. 

To perform CNA, MedStar Health electrophysiology experts work as a team with cardiologists to help ensure each patient gets holistic care before, during, and after their procedure.

Who can benefit from CNA?

Because CNA is an emerging therapy, it is reserved for patients with severe VVS. You may be a candidate if you meet several criteria, including:

• Frequent and unpredictable fainting episodes, such as three or more in the last six months or one or more episode that causes an injury to the face or head

• No improvement with traditional medications and lifestyle modifications 

• Diagnostic testing that confirms your syncope is consistently linked to a severe drop in heart rate. Tests include a tilt table test to monitor your heart while you change position and cardiac monitoring, a wearable or implantable device that records the heart’s electrical activity.

The success of CNA is closely related to this careful screening. Before ablating nerves in the heart, it’s critical to confirm they’re the cause of fainting rather than structural heart disease or rhythm issues. When CNA is performed for patients who are most likely to benefit, the outcomes are excellent.

When to talk with your doctor about fainting.

While loss of consciousness can be harmless, it can sometimes be the first sign of a more serious, life-threatening heart condition. See a doctor for a full evaluation whenever you faint.

If you experience fainting that results in an injury, happens often or without warning, or spells that occur despite getting treatment, ask your doctor if you should speak with a heart specialist about whether cardioneural ablation could be an effective treatment option for you.