Un enfoque adaptado de cardioneuroablación para síncope reflejo y bradicardia funcional. Resultados del estudio...

Cardioneuroablation (CNA) is a catheter-based intervention for reflex syncope and functional bradyarrhythmias that consists in the modulation of the parasympathetic cardiac autonomic nervous by targeting ganglionated plexi (GPs).To compare an ablation strategy of selective GP targeting based on clinical phenotype (tailored approach) versus the standard approach of targeting all GPs (standard approach).

This is a prospective, multicenter European study (ELEGANCE), including 123 patients who underwent CNA (73 men; median age 50 years). Among them 54 (44%) were treated with a tailored approach, targeting the SPSGP for sinus node dysfunction and the IPSGP for AV block symptoms. Procedural data and clinical outcomes were compared with the remaining 69 patients treated using a standard approach.Clinical phenotypes included isolated functional sinus node dysfunction (43.1%), isolated functional AV block (9.8%), and dual presentations (47.2%). In the tailored group 1.6 ± 0.7 GP were targeted per patient. Compared to the standard approach, the tailored group had significantly shorter procedure times (63 vs 85 minutes, p=0.005) and reduced RF time (5.4 vs. 10.4 minutes, p < 0.001). Acute procedural success (tailored: 93% vs. standard: 90%, p = 0.98) and the increase in heart rate (tailored: 40 ± 30.7% vs standard: 40 ± 31.4%, p = 0.96) were similar between groups. During a median 15.9 months [IQR: 9.8, 24.6] follow-up, there were no differences in syncope recurrence rate (log-rank p = 0.96). Inappropriate sinus tachycardia occurred in 8.1% of patients, (tailored 8.6% vs standard 7.4%; p = 0.79).

An individualized CNA strategy, simplified by targeting specific GPs according to patient's pathophysiology, achieved outcomes equivalent to the standard approach while improving procedural efficiency through reduced RF delivery, shorter procedure duration, and limited ablation extent.