Cardioneuroablation (CNA) is emerging as an appealing therapeutic option for patients with vasovagal reflex syncope. This review examines key aspects of CNA, including patient selection, procedural aspects and mid-term effects. We critically evaluate procedural results from recent studies and address ongoing challenges, such as the need for standardized procedural protocols and harmonized postprocedural data collection. In addition, we outline current gaps in knowledge concerning long-term pathophysiological effects of the procedure, in particular regarding ventricular arrhythmia susceptibility and exercise capacity.