{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T23:54:07Z","timestamp":1785801247530,"version":"3.56.0"},"reference-count":20,"publisher":"Oxford University Press (OUP)","issue":"1","license":[{"start":{"date-parts":[[2025,12,30]],"date-time":"2025-12-30T00:00:00Z","timestamp":1767052800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Italian Ministry of Health\u2019s \u2018Ricerca Corrente\u2019 funding from the IRCCS Humanitas Research Hospital"},{"name":"Societ\u00e0 Italiana di Cardiologia to CG"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,1,12]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Aims<\/jats:title>\n                    <jats:p>Cardioneuroablation (CNA) is a catheter-based intervention for reflex syncope and functional bradyarrhythmias that consists in the modulation of the parasympathetic cardiac autonomic nervous by targeting ganglionated plexi (GPs).<\/jats:p>\n                    <jats:p>To compare an ablation strategy of selective GP targeting based on clinical phenotype (tailored approach) vs. the standard approach of targeting all GPs (standard approach).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods and results<\/jats:title>\n                    <jats:p>This is a prospective, multicentre European study (ELEGANCE study), including 123 patients who underwent CNA (73 men; median age 50 years). Among them 54 (44%) were treated with a tailored approach, targeting the superior paraseptal ganglionated plexus (SPSGP) for sinus node dysfunction and the inferior paraseptal ganglionated plexus (IPSGP) for AV block. Procedural data and clinical outcomes were compared with the remaining 69 patients treated using a standard approach.<\/jats:p>\n                    <jats:p>Clinical phenotypes included isolated functional sinus node dysfunction (43.1%), isolated functional AV block (9.8%), and dual presentations (47.2%). In the tailored group 1.6 \u00b1 0.7 GPs were targeted per patient. Compared to the standard approach, the tailored group had significantly shorter procedure times (63 vs. 85\u2005min, P = 0.005) and reduced RF time (5.4 vs. 10.4\u2005min, P &amp;lt; 0.001). Acute procedural success (tailored: 93% vs. standard: 90%, P = 0.98) and the increase in heart rate (tailored: 40 \u00b1 30.7% vs. standard: 40 \u00b1 31.4%, P = 0.96) were similar between groups. During a median 15.9 months [IQR: 9.8, 24.6] follow-up, there were no differences in syncope recurrence rate (log-rank P = 0.96). Inappropriate sinus tachycardia occurred in 8.1% of patients, (tailored 8.6% vs. standard 7.4%; P = 0.79).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>An individualized CNA strategy, simplified by targeting specific GPs according to patient\u2019s pathophysiology, achieved outcomes equivalent to the standard approach while improving procedural efficiency through reduced RF delivery, shorter procedure duration, and limited ablation extent.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/europace\/euaf320","type":"journal-article","created":{"date-parts":[[2025,12,12]],"date-time":"2025-12-12T13:10:22Z","timestamp":1765545022000},"source":"Crossref","is-referenced-by-count":2,"title":["A tailored approach to cardioneuroablation for reflex syncope and functional bradycardia: results from the ELEGANCE multicentre study"],"prefix":"10.1093","volume":"28","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-2266-0344","authenticated-orcid":false,"given":"Carlo","family":"Gigante","sequence":"first","affiliation":[{"name":"Arrhythmia Department, Heart Institute, Teknon Medical Center , c. Villana, 12, Barcelona 08022, Spain"},{"name":"Facultat de Medicina I Ci\u00e8ncies de la Salut, Universitat de Barcelona (UB) , c. Casanova, 143, Barcelona 08036 ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0009-7221-4829","authenticated-orcid":false,"given":"Diego","family":"Penela","sequence":"additional","affiliation":[{"name":"Arrhythmia Department, Humanitas Research Hospital IRCCS, Rozzano, Milan ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8317-561X","authenticated-orcid":false,"given":"Daniel","family":"Viveros","sequence":"additional","affiliation":[{"name":"Arrhythmia Department, Heart Institute, Teknon Medical Center , c. Villana, 12, Barcelona 08022, Spain"},{"name":"Facultat de Medicina I Ci\u00e8ncies de la Salut, Universitat de Barcelona (UB) , c. Casanova, 143, Barcelona 08036 ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7128-9911","authenticated-orcid":false,"given":"Giulio","family":"Falasconi","sequence":"additional","affiliation":[{"name":"Arrhythmia Department, Heart Institute, Teknon Medical Center , c. Villana, 12, Barcelona 08022, Spain"},{"name":"Facultat de Medicina I Ci\u00e8ncies de la Salut, Universitat de Barcelona (UB) , c. Casanova, 143, Barcelona 08036 ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5626-0336","authenticated-orcid":false,"given":"Lucio","family":"Teresi","sequence":"additional","affiliation":[{"name":"Arrhythmia Department, Heart Institute, Teknon Medical Center , c. Villana, 12, Barcelona 08022, Spain"},{"name":"Facultat de Medicina I Ci\u00e8ncies de la Salut, Universitat de Barcelona (UB) , c. Casanova, 143, Barcelona 08036 ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6024-6278","authenticated-orcid":false,"given":"Alessia Chiara","family":"Latini","sequence":"additional","affiliation":[{"name":"Arrhythmia Department, Humanitas Research Hospital IRCCS, Rozzano, Milan ,","place":["Italy"]},{"name":"Department of Biomedical Sciences, Humanitas University , Pieve Emanuele-Milan ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1394-6260","authenticated-orcid":false,"given":"David","family":"Soto-Iglesias","sequence":"additional","affiliation":[{"name":"Arrhythmia Department, Heart Institute, Teknon Medical Center , c. Villana, 12, Barcelona 08022, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6157-058X","authenticated-orcid":false,"given":"Paula","family":"Franco-Oca\u00f1a","sequence":"additional","affiliation":[{"name":"Arrhythmia Department, Heart Institute, Teknon Medical Center , c. Villana, 12, Barcelona 08022, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0306-7764","authenticated-orcid":false,"given":"Pietro","family":"Francia","sequence":"additional","affiliation":[{"name":"Cardiology Department, St. Andrea Hospital, Rome ,","place":["Italy"]},{"name":"Department of Clinical and Molecular Medicine, Sapienza University, Rome ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0318-5349","authenticated-orcid":false,"given":"Jos\u00e9","family":"Alderete","sequence":"additional","affiliation":[{"name":"Arrhythmia Department, Heart Institute, Teknon Medical Center , c. Villana, 12, Barcelona 08022, Spain"},{"name":"Facultat de Medicina I Ci\u00e8ncies de la Salut, Universitat de Barcelona (UB) , c. Casanova, 143, Barcelona 08036 ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9579-5413","authenticated-orcid":false,"given":"Dario","family":"Turturiello","sequence":"additional","affiliation":[{"name":"Arrhythmia Department, Heart Institute, Teknon Medical Center , c. Villana, 12, Barcelona 08022, Spain"},{"name":"Facultat de Medicina I Ci\u00e8ncies de la Salut, Universitat de Barcelona (UB) , c. Casanova, 143, Barcelona 08036 ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Aldo Francisco","family":"Bellido","sequence":"additional","affiliation":[{"name":"Arrhythmia Department, Heart Institute, Teknon Medical Center , c. Villana, 12, Barcelona 08022, Spain"},{"name":"Arrhythmia Department, Hospital El Pilar, Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0706-1987","authenticated-orcid":false,"given":"Fatima","family":"Zaraket","sequence":"additional","affiliation":[{"name":"Arrhythmia Department, Heart Institute, Teknon Medical Center , c. Villana, 12, Barcelona 08022, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0130-6218","authenticated-orcid":false,"given":"Chiara","family":"Valeriano","sequence":"additional","affiliation":[{"name":"Arrhythmia Department, Humanitas Research Hospital IRCCS, Rozzano, Milan ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0001-6515-9931","authenticated-orcid":false,"given":"Roberta","family":"Mea","sequence":"additional","affiliation":[{"name":"Arrhythmia Department, Heart Institute, Teknon Medical Center , c. Villana, 12, Barcelona 08022, Spain"},{"name":"Department of Biomedical and Clinical Sciences, University of Milan, Milan ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bruno","family":"Tonello","sequence":"additional","affiliation":[{"name":"Arrhythmia Department, Heart Institute, Teknon Medical Center , c. Villana, 12, Barcelona 08022, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6075-7795","authenticated-orcid":false,"given":"Lautaro","family":"Sanchez-Moll\u00e1","sequence":"additional","affiliation":[{"name":"Arrhythmia Department, Heart Institute, Teknon Medical Center , c. Villana, 12, Barcelona 08022, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carmine","family":"De Lucia","sequence":"additional","affiliation":[{"name":"Arrhythmia Department, Heart Institute, Teknon Medical Center , c. Villana, 12, Barcelona 08022, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maria","family":"Matiello","sequence":"additional","affiliation":[{"name":"Arrhythmia Department, Hospital General de Catalunya, Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1700-6604","authenticated-orcid":false,"given":"Juan","family":"Fern\u00e1ndez-Armenta","sequence":"additional","affiliation":[{"name":"Arrhythmia Department, Puerta del Mar University Hospital, C\u00e1diz ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rodolfo","family":"San Antonio","sequence":"additional","affiliation":[{"name":"Cardiology Department, Bellvitge University Hospital, BIO-HEART Cardiovascular Research Group (IDIBELL), l'Hospitalet de Llobregat , Barcelona ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9475-1507","authenticated-orcid":false,"given":"Andrea","family":"Saglietto","sequence":"additional","affiliation":[{"name":"Division of Cardiology, Cardiovascular and Thoracic Department, Citt\u00e0 Della Salute e Della Scienza Hospital , Turin ,","place":["Italy"]},{"name":"Department of Medical Sciences, University of Turin , Turin ,","place":["Italy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8043-6055","authenticated-orcid":false,"given":"Jos\u00e9-Tom\u00e1s","family":"Ortiz-P\u00e9rez","sequence":"additional","affiliation":[{"name":"Arrhythmia Department, Heart Institute, Teknon Medical Center , c. Villana, 12, Barcelona 08022, Spain"},{"name":"Facultat de Medicina I Ci\u00e8ncies de la Salut, Universitat de Barcelona (UB) , c. Casanova, 143, Barcelona 08036 ,","place":["Spain"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9927-1190","authenticated-orcid":false,"given":"Julio","family":"Mart\u00ed-Almor","sequence":"additional","affiliation":[{"name":"Arrhythmia Department, Heart Institute, Teknon Medical Center , c. Villana, 12, Barcelona 08022, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5418-383X","authenticated-orcid":false,"given":"Antonio","family":"Berruezo","sequence":"additional","affiliation":[{"name":"Arrhythmia Department, Heart Institute, Teknon Medical Center , c. Villana, 12, Barcelona 08022, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2025,12,30]]},"reference":[{"key":"2026012811032154200_euaf320-B1","doi-asserted-by":"crossref","DOI":"10.1093\/europace\/euad163","article-title":"Twenty-five years of research on syncope","volume":"25","author":"Fedorowski","year":"2023","journal-title":"Europace"},{"key":"2026012811032154200_euaf320-B2","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.eupc.2004.10.003","article-title":"\u201cCardioneuroablation\u201d-new treatment for neurocardiogenic syncope, functional AV block and sinus dysfunction using catheter RF-ablation","volume":"7","author":"Pachon","year":"2005","journal-title":"Europace"},{"key":"2026012811032154200_euaf320-B3","doi-asserted-by":"crossref","DOI":"10.1093\/europace\/euad170","article-title":"Computed tomography-based identification of ganglionated plexi to guide cardioneuroablation for vasovagal syncope","volume":"25","author":"Francia","year":"2023","journal-title":"Europace"},{"key":"2026012811032154200_euaf320-B4","doi-asserted-by":"crossref","DOI":"10.1093\/europace\/euae206","article-title":"Cardioneuroablation for the treatment of reflex syncope and functional bradyarrhythmias: a scientific statement of the European Heart Rhythm Association (EHRA) of the ESC, the Heart Rhythm Society (HRS), the Asia Pacific Heart Rhythm Society (APHRS) and the Latin American Heart Rhythm Society (LAHRS)","volume":"26","author":"Aksu","year":"2024","journal-title":"Europace"},{"key":"2026012811032154200_euaf320-B5","doi-asserted-by":"crossref","DOI":"10.1093\/europace\/euae164","article-title":"Procedural and intermediate-term results of the electroanatomical-guided cardioneuroablation for the treatment of supra-hisian second- or advanced-degree atrioventricular block: the PIRECNA multicentre registry","volume":"26","author":"Aksu","year":"2024","journal-title":"Europace"},{"key":"2026012811032154200_euaf320-B6","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1016\/j.jacep.2022.08.011","article-title":"Cardioneuroablation for reflex syncope: efficacy and effects on autonomic cardiac regulation-A prospective randomized trial","volume":"9","author":"Piotrowski","year":"2023","journal-title":"JACC Clin Electrophysiol"},{"key":"2026012811032154200_euaf320-B7","doi-asserted-by":"crossref","DOI":"10.1093\/europace\/euad033","article-title":"Clinical controversy: methodology and indications of cardioneuroablation for reflex syncope","volume":"25","author":"Brignole","year":"2023","journal-title":"Europace"},{"key":"2026012811032154200_euaf320-B8","doi-asserted-by":"crossref","first-page":"50","DOI":"10.1016\/j.ijcard.2019.12.003","article-title":"Vagal responses during cardioneuroablation on different ganglionated plexi: is there any role of ablation strategy?","volume":"304","author":"Aksu","year":"2020","journal-title":"Int J Cardiol"},{"key":"2026012811032154200_euaf320-B9","doi-asserted-by":"crossref","first-page":"289","DOI":"10.1002\/(SICI)1097-0185(199702)247:2<289::AID-AR15>3.0.CO;2-L","article-title":"Gross and microscopic anatomy of the human intrinsic cardiac nervous system","volume":"247","author":"Armour","year":"1997","journal-title":"Anat Rec"},{"key":"2026012811032154200_euaf320-B10","doi-asserted-by":"crossref","DOI":"10.1093\/europace\/euae102.290","article-title":"Cardioneuroablation for vasovagal syncope. Results from an EHRA Survey","volume":"26","author":"Penela","year":"2024","journal-title":"Europace"},{"key":"2026012811032154200_euaf320-B11","doi-asserted-by":"crossref","first-page":"1279","DOI":"10.1016\/j.hrthm.2023.06.007","article-title":"Clinical impact of aging on outcomes of cardioneuroablation for reflex syncope or functional bradycardia: results from the cardionEuroabLation: patiEnt selection, imaGe integrAtioN and outComEs\u2014the ELEGANCE multicenter study","volume":"20","author":"Francia","year":"2023","journal-title":"Heart Rhythm"},{"key":"2026012811032154200_euaf320-B12","doi-asserted-by":"crossref","first-page":"1224","DOI":"10.1016\/j.jacep.2019.06.011","article-title":"High-frequency, low tidal volume ventilation to improve catheter stability during atrial fibrillation ablation","volume":"5","author":"Gabriels","year":"2019","journal-title":"JACC Clin 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