Long‐term outcomes of cardioneuroablation with and without extra‐cardiac vagal stimulation confirmation in severe cardioinhibitory neurocardiogenic syncope

Abstract

BackgroundCardioneuroablation (CNA) is a novel therapeutic approach for functional bradyarrhythmias, specifically neurocardiogenic syncope or atrial fibrillation, achieved through endocardial radiofrequency catheter ablation of vagal innervation, obviating the need for pacemaker implantation. Originating in the nineties, the first series of CNA procedures was published in 2005. Extra‐cardiac vagal stimulation (ECVS) is employed as a direct method for stepwise denervation control during CNA.ObjectiveThis study aimed to compare the long‐term follow‐up outcomes of patients with severe cardioinhibitory syncope undergoing CNA with and without denervation confirmation via ECVS.MethodA cohort of 48 patients, predominantly female (56.3%), suffering from recurrent syncope (5.1 ± 2.5 episodes annually) that remained unresponsive to clinical and pharmacological interventions, underwent CNA, divided into two groups: ECVS and NoECVS, consisting of 34 and 14 cases, respectively. ECVS procedures were conducted with and without atrial pacing.ResultsDemographic characteristics, left atrial size, and ejection fraction displayed no statistically significant differences between the groups. Follow‐up duration was comparable, with 29.1 ± 15 months for the ECVS group and 31.9 ± 20 months for the NoECVS group (p = .24). Notably, syncope recurrence was significantly lower in the ECVS group (two cases vs. four cases, Log Rank p = .04). Moreover, the Hazard ratio revealed a fivefold higher risk of syncope recurrence in the NoECVS group.ConclusionThis study demonstrates that concluding CNA with denervation confirmation via ECVS yields a higher success rate and a substantially reduced risk of syncope recurrence compared to procedures without ECVS confirmation.

Recent Advances and Future Directions in Syncope Management: A Comprehensive Narrative Review

“…According to their results, the freedom-from-syncope (FFS) after CNA was 91.9% (95% confidence interval (CI) 88.1-94.6%; p = 0.376), with higher rates of FFS for left atrial ablation (94.0%; 95% CI 88.6-96.9%) and biatrial ablation (92.7%; 95% CI 86.8-96.1%) than right atrial ablation (81.5%; 95% CI 51.9-94.7%; p < 0.0001) [94]. A recent study conducted on 48 patients with recurrent syncope showed lower recurrence rates of syncope in the CNA group compared to the non-CNA group [95]. However, despite the promising results, multiple issues arose regarding the selection of potential patients, ideal ablation site, verification of the ablation effect, and long-term durability of the procedure [96,97].…”

Do we have a clear end‐point for cardioneuroablation?

“…In this issue of the Journal, Pachon et al describe long-term outcomes of cardioneuroablation with and without ECVS confirmation in severe cardioinhibitory neurocardiogenic syncope. 28 A cohort of 48 patients suffering from recurrent neurocardiogenic syncope underwent cardioneuroablation and was divided into two groups: ECVS-guided and control group with ablation at the sites identified by the AF nests without ECVS confirmation. Demographic characteristics and follow up duration were comparable between both study groups.…”