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Empirical Anatomical Versus HAFE-Guided Cardioneuroablation for Vasovagal Syncope: Long-Term Efficacy and Safety

Bo Zhang1,2, Xianfeng Du3,4, Chenxu Luo1

  • 1Health Science Center, Ningbo University, Ningbo City, China.

Clinical Cardiology
|May 18, 2026
PubMed

Insights

Cardioneuroablation (CNA) for vasovagal syncope (VVS) showed similar long-term effectiveness between empirical anatomical-guided CNA (EAGC) and high-amplitude fractionated electrogram (HAFE)-guided CNA. HAFE-guided CNA improved procedural efficiency and reduced radiation exposure.

Area of Science:

  • Cardiology
  • Electrophysiology
  • Medical Devices

Background:

  • Vasovagal syncope (VVS) presents ongoing therapeutic challenges.
  • The optimal approach for cardioneuroablation (CNA) targeting ganglionated plexi (GPs) remains under investigation.
  • Refractory VVS cases require evaluation of advanced treatment strategies.

Purpose of the Study:

  • To compare the long-term efficacy and safety of empirical anatomical-guided CNA (EAGC) versus high-amplitude fractionated electrogram (HAFE)-guided CNA in patients with refractory VVS.
  • To assess differences in procedural metrics, quality of life, and complication rates between the two CNA approaches.

Main Methods:

  • A single-center retrospective analysis included 109 patients with refractory VVS undergoing CNA from July 2018 to July 2023.
  • Patients were categorized into EAGC (n=70) or HAFE-guided CNA (n=39) groups.
  • The primary endpoint was 24-month syncope-free survival, with secondary endpoints including procedural metrics and quality of life.

Main Results:

  • No significant difference in 24-month syncope-free survival was found between EAGC (85.6%) and HAFE-guided CNA (77.2%) groups (p=0.285).
  • The HAFE group showed significantly shorter procedure times (p<0.001), reduced radiation exposure (p=0.002), and less fluoroscopy time (p<0.001).
  • Both groups achieved significant quality of life improvements (SDS reduction), with comparable complication rates.

Conclusions:

  • Both EAGC and HAFE-guided CNA offer comparable long-term syncope-free survival for refractory VVS.
  • HAFE-guided CNA demonstrates superior procedural efficiency and reduced radiation exposure compared to EAGC.
  • Neither method showed a significant difference in VVS recurrence risk.
Abstract

Keywords:
cardioneuroablationganglionated plexiquality of liferadiation exposuresyncope recurrence

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