What is your approach to patient selection for cardioneuroablation for vasovagal syncope?

Cardioneuroablation (CNA) for vasovagal syncope is a potential treatment that I have enthusiasm for but my use is tempered by limitations in the currently available evidence base. My opinion is that the majority of patients with vasovagal syncope(VVS) should not undergo this procedure, especially in light of current limitations, however, I do think this is a viable treatment for a small subset of patients and warrants further assessment with a multicenter, randomized sham-controlled trial.

The enthusiasm for CNA reminds me a lot of the early trials for pacemakers for VVS with small, non-sham controlled trials indicating a benefit, but later controlled trials like VPS2 not demonstrating this (Connolly et al., PMID 12734133). In our syncope cl...