The benefit of cardioneuroablation to reduce syncope recurrence in vasovagal syncope patients: a case-control study
Tolga Aksu1, Deepak Padmanabhan2, Jayaprakash Shenthar2
1Department of Cardiology, Kocaeli Derince Education and Research Hospital, University of Health Sciences, 41500 Derince, Kocaeli, Turkey. aksutolga@gmail.com.
Insights
Cardioneuroablation (CNA) significantly reduces syncope recurrence in patients with resistant vasovagal syncope. This study found CNA more effective than conservative therapy (CT) for long-term symptom-free survival.
Area of Science:
- Cardiology
- Electrophysiology
- Neurally Mediated Syncope
Background:
- Vasovagal syncope (VVS) management remains challenging, with limited effective therapies for resistant cases.
- The efficacy of cardioneuroablation (CNA) for VVS is debated.
- This study evaluates the long-term outcomes of CNA versus conservative therapy (CT) in VVS patients.
Purpose of the Study:
- To assess the long-term effectiveness of cardioneuroablation (CNA) compared to conservative therapy (CT).
- To evaluate syncope recurrence rates in patients with resistant vasovagal syncope.
Main Methods:
- Retrospective cohort study including 101 patients with positive head-up tilt test (HUT) results.
- Patients were divided into two groups: CNA (n=51) and CT (n=50).
- Propensity score matching created 19 pairs for comparative analysis of syncope recurrence.
Main Results:
- Over a median follow-up of 22 months, 11.8% of patients experienced syncope.
- In matched pairs, recurrent syncope occurred in 2/19 patients after CNA versus 8/19 after CT.
- CNA was associated with a reduced risk of syncope recurrence (HR 0.23, p=0.049).
Conclusions:
- Cardioneuroablation (CNA) significantly reduces syncope recurrence in selected patients with HUT-induced cardioinhibitory vasovagal syncope.
- CNA demonstrates superior long-term efficacy compared to conservative therapy (CT) in this patient cohort.
- The 4-year syncope-free rate was substantially higher for CNA (86%) than CT (50%).
Background:
Adequate and effective therapy for resistant vasovagal syncope patients is lacking and the benefit of cardioneuroablation (CNA) in this cohort is still debated. The aim of this study is to assess the long-term effect of CNA versus conservative therapy (CT) in a retrospectively followed cohort.
Methods:
A total of 2874 patients underwent head-up tilt test (HUT) and 554 (19.2 %) were reported as positive, with VASIS type 2B response or > 3 s asystole in 130 patients. After exclusion of 29 patients under 18 years and over 65 years of age, 101 patients were included final analysis. Fifty-one patients (50.4%) underwent CNA and 50 (49.6%) patients received CT. After propensity score matching, 19 pairs of patients were successfully matched. The recurrence rate of syncope was compared between groups.
Results:
During a median follow-up of 22 months (IQR, 13-35), syncope was seen in 12 (11.8%) cases. In the 19 propensity-matched patients, recurrent syncope was observed in 8 patients in the CT group and in 2 patients in the CNA group, respectively. In mixed effect Cox regression analysis, CNA was associated with less syncope recurrence risk at follow-up (HR 0.23, 95% CI 0.03-0.99, p = 0.049). The 4-year Kaplan-Meier syncope free rate was 0.86 (95% CI, 0.63-1.00) for CNA group and 0.50 (95% CI, 0.30-0.82) for CT group in the matched cohort.
Conclusions:
In highly selected patients with HUT-induced cardioinhibitory response, CNA is associated with a significant reduction in syncope recurrence during follow-up when compared to CT.
More Related Videos
Related Concept Videos
01:29Cardiomyopathy V: Interprofessional Care
01:25Dysrhythmias VI: Management of Dysrhythmias
01:28Mechanism of Cardiac Arrhythmias
01:25Cardiopulmonary Resuscitation IV: Pharmacological Management
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
01:30Cardiomyopathy II: Dilated Cardiomyopathy