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Cardioneuroablation in patients with vasovagal syncope: An updated systematic review and meta-analysis
Alonzo Armani Prata1, Eric Katsuyama2, Pedro Scardini3
1Department of Medicine, Federal University of Espirito Santo, Vitória, Brazil.
Insights
Cardioneuroablation (CNA) effectively reduces syncope recurrence in vasovagal syncope (VVS) patients. However, specific methods like electroanatomic mapping and right atrium approaches show higher recurrence rates, warranting careful consideration.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Procedures
Background:
- Cardioneuroablation (CNA) is an emerging procedure for refractory vasovagal syncope (VVS).
- Existing evidence on CNA's effectiveness and safety in VVS patients is debated.
- This meta-analysis addresses the controversy surrounding CNA in VVS management.
Purpose of the Study:
- To conduct an updated meta-analysis on the efficacy and safety of CNA for refractory VVS.
- To evaluate syncope recurrence rates and periprocedural complications following CNA.
- To explore variations in outcomes based on targeting methods and ablation locations.
Main Methods:
- Systematic literature search of PubMed, Embase, and Cochrane databases for CNA studies in VVS.
- Inclusion of 27 observational studies and 1 RCT with 1153 patients.
- Primary endpoints: syncope recurrence and periprocedural complications; subgroup analyses by GP targeting and location.
Main Results:
- CNA demonstrated an overall syncope recurrence rate of 5.94% and a complication rate of 0.99%.
- Electroanatomic mapping for ganglionated plexus (GP) targeting showed a 6.21% recurrence rate.
- Right atrium approach for GP ablation was associated with a higher recurrence rate (15.78%).
Conclusions:
- This meta-analysis supports the efficacy and safety of CNA in preventing syncope recurrence in VVS patients.
- Electroanatomic mapping and right atrium approaches for GP targeting/ablation are linked to increased syncope recurrence.
- Findings suggest optimizing CNA techniques may further improve patient outcomes.
Background:
Cardioneuroablation (CNA) is a novel procedure that shows promising results in reducing syncope recurrence in patients with refractory vasovagal syncope (VVS). However, its effectiveness and safety remain controversial.
Objective:
We performed an updated meta-analysis evaluating CNA efficacy and safety in patients with refractory VVS.
Methods:
PubMed, Embase, and Cochrane databases were systematically searched for CNA studies in patients with refractory VVS. Our primary efficacy end point was syncope recurrence, and our safety end point was periprocedural complications. Prespecified subgroup analyses were performed for (1) the ganglionated plexus (GP) targeting method and (2) the GP location of ablation.
Results:
We included 27 observational studies and 1 randomized controlled trial encompassing 1153 patients with refractory VVS who underwent CNA. The median age was 39.6 years, and follow-up was 21.4 months. The overall weighted rate of syncope recurrence after CNA was 5.94% (95% confidence interval [CI] 3.37%-9.01%; I2 = 64%), and the rate of periprocedural complications was 0.99% (95% CI 0.14%-2.33%; I2 = 0%). Our prespecified subgroup analysis using the GP targeting method and GP ablation location showed a higher prevalence of syncope recurrence in the electroanatomic mapping subgroup (6.21%; 95% CI 2.93%-10.28%; I2 = 0%) and in the right atrium approach (15.78%; 95% CI 3.61%-33.14%; I2 = 65.2%).
Conclusion:
This study supports the efficacy and safety of CNA in preventing syncope recurrence in patients with VVS. Furthermore, the electroanatomic mapping method of GP targeting and the right atrium approach were associated with a higher syncope recurrence rate than other methods.
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