Older age is not an independent predictor of syncope recurrence following cardioneuroablation for reflex syncope

Cardioneuroablation (CNA) is a promising tool to treat reflex syncope; however, optimal age cut-off values to undergo CNA have not been established.

This is a prospective observational single-center study which included all consecutive patients with cardioinhibitory reflex syncope treated with CNA who completed at least 1 year of follow-up. Bi-atrial CNA was performed using anatomical approach with the use of electro-anatomical mapping system, intracardiac echocardiography and extracardiac vagal stimulation.

The study group consisted of 209 patients (mean age 39.5 ± 13.6, 121 (58%) females). During a median follow-up of 27 months, 166 (79.4%) patients remained free from syncope recurrence, and syncope burden was significantly reduced (6.67 syncope/year vs. 0.26 syncope/year, p = 0.00001). Univariate analysis showed that hypertension, number of syncopal episodes, and age ≥ 60 years were associated with syncope recurrence; however, age was not an independent variable predicting the outcome. There was no significant difference in the outcome between patients aged < 40 vs. ≥ 40 or < 50 vs. ≥ 50 years. The reduction of syncope burden was significant in younger age groups but not in patients aged ≥ 60 years. During follow-up, six patients received pacemaker-all were >50 years old.

Age is not an independent predictor of CNA efficacy; however, patients aged >60 years, particularly those with concomitant hypertension and a high number of syncopal episodes, tend to have higher syncope recurrence and less reduction in syncope burden than younger people. The need for permanent pacing due to ineffective CNA increases with age, starting from 55 years.