Cardioneuroablation Acutely Affects the Amplitude and Efficiency of Respiratory Heart Rate Variability

Sep 30, 2026

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Cardioneuroablation (CNA) treats reflex syncope through parasympathetic denervation, yet its effects on respiratory heart rate variability (RespHRV) components are unclear. Eleven subjects undergoing CNA for cardioinhibitory vagally mediated syncope were assessed using continuous respiratory flow and electrocardiography. RespHRV amplitude (RespHRVpv) and efficiency (% short-RRi inspirations and % long-RRi expirations) were analyzed, with baroreflex sensitivity measured 48 h before and after. CNA markedly reduced amplitude and both efficiency indices, with ΔBRS correlating strongly with ΔRespHRVpv.

LanguageEnglish

CategoryHealthcare

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Abstract

Introduction

Brief Report Cardioneuroablation Acutely Affects the Amplitude and Efficiency of Respiratory Heart Rate Variability Piotr Niewinski 1,2, *, Stanislaw Tubek 1,2, Krzysztof Nowak 1,2, Krystian Josiak 3 and Bartłomiej Paleczny 4 Academic Editors: Isabel Rocha and Sérgio Laranjo Received: 23 November 2025 Revised: 28 December 2025 Accepted: 2 January 2026 Published: 5 January 2026 Copyright: © 2026 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license. 1 Institute of Heart Diseases, Faculty of Medicine, Wroclaw Medical University, 50-556 Wroclaw, Poland; [stanislaw.tubek@umw.edu.pl](stanislaw.tubek@umw.edu.pl) (S.T.); [krzysztof.nowak@umw.edu.pl](krzysztof.nowak@umw.edu.pl) (K.N.) 2 Clinical Department of Cardiology, Jan Mikulicz-Radecki University Hospital, 50-556 Wroclaw, Poland 3 Department of Cardiology, 4th Military Hospital, 50-981 Wroclaw, Poland; [elektrofizjologia@4wsk.pl](elektrofizjologia@4wsk.pl) [4](4 Department of Physiology and Pathophysiology)[ Department of Physiology and Pathophysiology](4 Department of Physiology and Pathophysiology), [Wroclaw Medical University](Wroclaw Medical University), [50-386 Wroclaw](50-386 Wroclaw), [Poland](Poland); [bartlomiej.paleczny@umw.edu.pl](bartlomiej.paleczny@umw.edu.pl) * [Correspondence: piotr.niewinski@umw.edu.pl](Correspondence: piotr.niewinski@umw.edu.pl); Tel.: +48-717331112 Abstract Background/Objectives: Cardioneuroablation (CNA) is used to treat reflex syncope by parasympathetic denervation of the cardiac conduction system. Respiratory heart rate variability (RespHRV) constitutes an important physiological mechanism that optimizeslung perfusion. The impact of CNA on various components of RespHRV remains unclear. Methods: Eleven subjects (36.8 ± 14.1 years) undergoing CNA for the treatment of cardioinhibitory, vagally mediated syncope were enrolled. For the RespHRV assessment, we used continuous respiratory flow measurement and an electrocardiogram. RespHRV analysis included the following: (a) amplitude, reflecting the overall magnitude of changes in RR interval during the respiratory cycle (RespHRVpv, ms); and (b) efficiency, defined as the percentage of inspirations accompanied by RR shortening (short-RRi inspirations,%), and expirations accompanied by RR prolongation (long-RRi expirations,%) . Baroreflex sensitivity (BRS, ms/mmHg) was assessed with a sequential method using a noninvasive hemodynamic monitor. Both RespHRV and BRS were captured 48 h apart, before and after CNA. Results: A significant reduction was observed in RespHRVpv (57 [30–131] vs. 13 [7–16] ms, p = 0.003), short-RRi inspirations (97.0 [77.8–100.0] vs. 36.0 [14.3–63.2]%, p = 0.003), and long-RRi expirations (88.0 [78.1–97.6] vs. 31.1 [21.4–65.8]%, p = 0.008) . Moreover, we found a strong relationship between ∆BRS and ∆RespHRVpv (r = 0.77, p = 0.005) following CNA. Conclusions: Our results indicate a substantial role of the cardiac parasympathetic system in RespHRV development, including both its amplitude and efficiency. The marked decrease in key RespHRV measures after CNA highlights the need for further research into its long-term clinical effects. Keywords: baroreflex; cardioneuroablation; cardiorespiratory coupling; heart rate; parasympathetic system; respiratory sinus arrhythmia; respiratory heart rate variability 1. Introduction Cardioneuroablation (CNA) has recently become a treatment option for neurogenic syncope [1] . CNA significantly affects heart rate variability, baroreflex function, and hypoxic reactivity of the sinus node [2,3] . The observed decrease in high-frequency (HF) power may indicate diminished heart rate (HR) modulation in response to breathing patterns [4]; however, this has not yet been examined through simultaneous recordings of HR and respiratory flow. The CNA model offers a unique opportunity to invest

FAQs

What is cardioneuroablation (CNA) and why is it used?

CNA is used to treat reflex syncope by parasympathetic denervation of the cardiac conduction system.

How was respiratory heart rate variability (RespHRV) evaluated in this study?

RespHRV was assessed using continuous respiratory flow measurement and electrocardiography. It included amplitude (RespHRVpv) and efficiency defined by RR shortening/prolongation aligned with respiratory phases.

What were the main findings after CNA regarding RespHRV?

After CNA, the study observed a significant reduction in RespHRV amplitude and in both efficiency measures. A strong relationship was also found between changes in baroreflex sensitivity and changes in RespHRVpv.

Sep 30, 2026

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