A new treatment technique at East Hospital prevents severe bradycardia episodes in two patients and improves quality of life

Rīga East Clinical University Hospital (East Hospital) has successfully performed, for the first time, an innovative radiofrequency-based cardioneuroablation procedure to prevent severe cardiac bradycardia episodes in two patients. The condition involves life-threatening slowing of heart rate resulting from excessive parasympathetic nervous system activation. The surgery was performed by East Hospital’s cardiac electrophysiologists in cooperation with cardiologist Aigars Rubulis, who is currently practising at Sahlgrenska University Hospital in Gothenburg.

Neurocardiogenic syncope occurs when malfunction of the parasympathetic nervous system causes a sudden drop in heart rate or blood pressure, leading to loss of consciousness. While the number of affected patients is small, physicians encounter such cases regularly. Until now, the only effective treatment for severe bradycardia – dangerously slow heart rate – has been pacemaker implantation, a solution that is often unsuitable for younger patients. Although clinical trials of new medications are currently under way and may offer future solutions, effective treatment options remain limited until these studies are completed.

One promising approach is cardioneuroablation – a procedure that blocks parasympathetic nerve signals to ganglia located in both atria of the heart. Destruction of these ganglia is achieved using radiofrequency energy, as in other advanced endocardial procedures. At East Hospital, this technique has already been successfully performed in two patients whose bradycardia episodes significantly affected their everyday lives and safety. One patient, a 63-year-old woman, experienced episodes of syncope possibly following a viral infection. Diagnostic investigations showed a marked parasympathetic response. The other patient, a 56-year-old man, suffered recurrent severe bradycardia episodes during stress-related situations, mainly associated with air travel, and did not respond to standard therapeutic approaches.

“I am glad to share my expertise and hands-on experience, as this technique is gaining increasing recognition in leading European clinics. East Hospital’s specialists have all the possibilities to become leaders in the development of this treatment technique,” points out cardiologist Aigars Rubulis, whose involvement enabled the first use of this technique at East Hospital.

Patient selection for this technique involves the use of the tilt table test to evaluate blood pressure and heart rate responses, as well as pharmacological testing to assess the feasibility of parasympathetic blockade.

“When introducing this type of surgeries, a multidisciplinary approach is crucial. Neurologists and functional diagnostics specialists play a key role in establishing an accurate diagnosis and determining the cause of bradycardia,” says Jurijs Verbovenko, cardiologist and Head of the Department of Cardiac Electrophysiology at East Hospital. The physician reveals that it is planned to establish a unified cardiology and neurology unit within the Neurology and Neurosurgery Clinic, to be led by Professor Guntis Karelis. This initiative aims to enable earlier identification of patients with these conditions, improve diagnostic accuracy, and provide innovative treatment options at East Hospital.

At the end of the cardioneuroablation procedures, bradycardia was deliberately induced in both patients. Subsequent nerve stimulation no longer triggered bradycardia, confirming the effectiveness of the innovative surgical technique. After the surgery, both patients were monitored in the Department of Cardiac Electrophysiology for three days and then discharged from inpatient care with complete resolution of the cardiac condition.

East Hospital’s multidisciplinary team that performed the cardioneuroablation procedures:

Jurijs Verbovenko – cardiologist, cardiac electrophysiologist, and Head of the Department of Cardiac Electrophysiology

Aigars Rubulis – cardiologist currently practising at Sahlgrenska University Hospital in Gothenburg

Svetlana Putne – cardiologist at the Department of Cardiac Electrophysiology

Agnese Stronsteina – general care nurse at the Interventional Cardiology Laboratory and the day hospital;

Mihails Starikovs – anaesthesiologist-intensivist in the Department of Anaesthesiology at Gaiļezers inpatient facility

Paula Kristiāna Lāce – anaesthesiology resident

Elīna Neilande – nurse anaesthetist

Ingūna Blaua – nurse anaesthetist

About the East Hospital 

Riga East Clinical University Hospital is the largest and strategically significant multi-profile hospital in the country. The hospital consists of five inpatient facilities – Gaiļezers, Latvian Oncology Centre, Biķernieki, Tuberculosis and Lung Disease Centre, and Latvian Infectious Diseases Centre, along with various specialised centres and clinics. The hospital provides highly specialised inpatient and secondary outpatient healthcare, offering multidisciplinary tertiary-level treatment and care in line with modern technology and medical knowledge. Approximately 80% of all cancer patients in Latvia are treated at the hospital. It serves as a practical training base for both Latvian educational institutions and foreign students, providing further education and knowledge transfer to healthcare specialists within and beyond the country. The hospital engages in scientific research and develops innovative methods for patient treatment. As the third-largest employer in the country, the hospital employs around 5000 staff members.