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Cardioneuroablation for Vasovagal Syncope: An Updated Systematic Review and Single-Arm Meta-Analysis
Alexandru Ababei1,2, Cosmin Gabriel Ursu2, Mircea Ioan Alexandru Bistriceanu2
1Iliescu Emergency Institute for Cardiovascular Diseases, 022328 Bucharest, Romania.
Insights
Ganglionated plexi catheter ablation may reduce vasovagal syncope (VVS) recurrence in select patients. However, high heterogeneity in current studies necessitates further randomized trials for definitive efficacy and safety confirmation.
Area of Science:
- Cardiology
- Electrophysiology
- Medical Interventions
Background:
- Vasovagal syncope (VVS) can be debilitating when conservative treatments fail.
- Permanent pacemakers and ganglionated plexi (GP) catheter ablation are procedural alternatives for refractory VVS.
Purpose of the Study:
- To evaluate the efficacy of GP catheter ablation in patients experiencing vasovagal syncope.
- To synthesize existing evidence on the recurrence rates of VVS post-ablation.
Main Methods:
- A comprehensive literature search was conducted across major databases (PubMed, Embase, Cochrane Library).
- A single-arm proportion meta-analysis was performed on 37 studies involving 1585 participants.
- Study selection and data extraction were conducted by two independent reviewers.
Main Results:
- The pooled recurrence rate of VVS after GP catheter ablation was 8.9% (95% CI, 6.4-11.4%).
- Significant heterogeneity was observed across studies (I² = 74.4%, p < 0.001).
- Sensitivity, subgroup, and meta-regression analyses did not identify significant effect modifiers or resolve heterogeneity.
Conclusions:
- GP catheter ablation shows potential for reducing VVS recurrence in specific patient groups.
- The current evidence is primarily from non-randomized studies, limiting definitive conclusions.
- High heterogeneity underscores the need for future randomized controlled trials with standardized protocols.
Abstract:
Background: When conservative therapies are insufficient for vasovagal syncope (VVS), procedural options such as permanent pacemakers or catheter ablation of ganglionated plexi (GP) may be considered. This meta-analysis aimed to evaluate the efficacy of GP catheter ablation in patients with VVS. Methods: A comprehensive literature search was performed in PubMed, Embase, and the Cochrane Library from 15 March 2024 to 10 May 2025. After duplicate removal, two reviewers independently screened studies and assessed full texts based on predefined criteria. A single-arm proportion meta-analysis was conducted. Results: Thirty-seven studies comprising 1585 participants were included. The pooled proportion of VVS recurrence after ablation was 8.9% (95% CI, 6.4-11.4%), but with substantial heterogeneity (I2 = 74.4%, p < 0.001). Sensitivity and subgroup analyses confirmed the robustness of the pooled estimate. A meta-regression was performed to further explore potential effect modifiers, but no covariate reached statistical significance. Conclusions: This meta-analysis suggests that ganglionated plexi catheter ablation may be associated with a reduced recurrence of vasovagal syncope in selected populations. However, the findings are based predominantly on non-randomized observational studies, and the high between-study heterogeneity limits the strength of inference. Future randomized controlled trials with standardized methodologies are needed to confirm the long-term efficacy and safety of this intervention.
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