Physiological Markers of Effective Autonomic Denervation Are Associated With Outcomes After Cardioneuroablation for Vasovagal Syncope.

BACKGROUND

Cardioneuroablation (CNA) has been increasingly pursued as a treatment for patients with recurrent vasovagal syncope. The optimal procedural approach and acute endpoints are unclear.

OBJECTIVE

The goal of this study was to characterize procedural markers linked to durable freedom from syncope.

METHODS

All patients who underwent CNA for vasovagal syncope refractory to lifestyle modification with at least 1 year of follow-up were included in a retrospective cohort. Clinical and procedural characteristics were analyzed for association with recurrence of syncope.

RESULTS

A total of 57 patients (mean age 39.8 ± 10.7 years; 53% female; 6.7 ± 3.8 episodes of syncope in the prior year) met inclusion criteria. During 2.2 ± 0.8 years of follow-up, 25 patients (44%) had recurrent syncope. Symptomatic inappropriate sinus tachycardia occurred in 14% and was more common after CNA guided by extracardiac vagal stimulation (64% vs 2%). Patients who remained free from recurrent syncope were more likely to exhibit a vagal response during ablation of the left-sided ganglionated plexus (56% vs 12%; P = 0.001), had a greater increase in sinus rate during the ablation (29.9 ± 15.1 beats/min vs 10.0 ± 15.8 beats/min; P = 0.01), and were less likely to exhibit a positive atropine response at the end of the procedure (3% vs 24%; P = 0.04). Patients who exhibited a greater number of these favorable physiological markers had progressively lower rates of recurrent syncope. Patients meeting all 3 criteria had the lowest recurrence rate (14%).

CONCLUSIONS

There is a substantial rate of recurrent syncope after CNA with intermediate-term follow-up. Inadequate acute procedural endpoints may be associated with recurrence.