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Cardioneuroablation (CNA), a novel intervention targeting the cardiac autonomic nervous system\u2019s ganglionated plexi, has shown promise in addressing refractory VVS. This review examines the therapeutic potential of CNA, exploring the anatomy and physiology of the cardiac autonomic nervous system, the role of ganglionated plexi in cardiac regulation and the rationale behind their selection as ablation targets. The review also discusses diverse strategies for ganglionated plexi identification and ablation. The gateway ganglionated plexi hypothesis is used to explain the success of CNA across varied procedural methods, despite the absence of a standardized technique. These gateway ganglionated plexi, located near the sinoatrial and atrioventricular nodes, potentially serve as central nodes influencing heart rhythm and rate, thus explaining the high success rates in VVS treatment using different approaches.<\/jats:p>","DOI":"10.15420\/aer.2024.36","type":"journal-article","created":{"date-parts":[[2025,1,14]],"date-time":"2025-01-14T11:45:22Z","timestamp":1736855122000},"source":"Crossref","is-referenced-by-count":4,"title":["Catheter Ablation for Vasovagal Syncope: The\u00a0Therapeutic Potential of Gateway Plexi"],"prefix":"10.15420","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3678-1932","authenticated-orcid":false,"given":"Mohamed","family":"Zuhair","sequence":"first","affiliation":[{"name":"National Heart and Lung Institute, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7472-7358","authenticated-orcid":false,"given":"Daniel","family":"Keene","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitrios","family":"Panagopoulos","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Louisa","family":"Malcolme-Lawes","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bradley","family":"Porter","sequence":"additional","affiliation":[{"name":"University Hospitals Plymouth NHS Trust, Plymouth, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3593-2185","authenticated-orcid":false,"given":"Prapa","family":"Kanagaratnam","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4888-0070","authenticated-orcid":false,"given":"Phang Boon","family":"Lim","sequence":"additional","affiliation":[{"name":"National Heart and Lung Institute, Imperial College London, London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"6096","published-online":{"date-parts":[[2025,1,14]]},"reference":[{"key":"ref0","doi-asserted-by":"publisher","unstructured":"Serletis A, Rose S, Sheldon AG, Sheldon RS. 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