Comparison Between Cardioneuroablation and Pacemaker Therapy in Patients with Functional Bradycardia

Background: This study sought to examine the efficacy and safety of cardioneuroablation (CNA) and pacemaker (PM) therapy in patients with functional bradycardia. Methods: We included 14 patients with functional bradycardia who underwent CNA or PM in our centre in Malaysia from 2019–2024 (CNA n=8; PM n=6). The primary efficacy endpoint was time to first syncope recurrence, switching from CNA to PM or from PM to CNA. The secondary efficacy endpoint was a composite of time to first syncope, presyncope or prodrome recurrence. The safety endpoint of the study was complications related to CNA or PM. Results: The median age of the patients for the CNA and PM groups was 46.5 and 37.5 years old (p=0.27), respectively. The median number of syncopal events before CNA or PM therapy was 2.2 and 2.5 (p=0.60), respectively. There were 62.5% of patients in the CNA group and 83.3% of patients in the PM group who had sustained traumatic injury post-syncope. At 1 year, the primary efficacy endpoint was met in one patient in the CNA group and one patient in the PM group (p=0.88). Recurrent syncope occurred in one patient in the PM group and no patients in the CNA group (p=0.25). The safety endpoint occurred in one patient in the PM group and none in the patients in the CNA group (p=0.25). Conclusion: CNA and PM appeared to be effective and safe for functional bradycardia patients. Larger studies with longer follow-ups are needed to establish long-term outcomes.