B-PO01-027 PERMANENT PACING VERSUS CARDIONEUROABLATION FOR CARDIOINHIBITORY VASOVAGAL SYNCOPE

Abstract

Permanent cardiac pacing (PM) can reduce syncopal events in patients with refractory cardioinhibitory (CI) vasovagal syncope (VVS). Cardioneuroablation (CNA) has been shown to be effective in reducing syncopal recurrences in patients with CI-VVS. To compare the safety and efficacy of CNA with PM in patients with recurrent CI-VVS. We conducted a 5-center, retrospective study of all patients who underwent CNA or received PM for recurrent, severe, CI-VVS. Clinical diagnosis of CI-VVS was supported by cardiac monitoring or positive cardioinhibitory response to head-up tilt testing. All patients had disabling symptoms with traumatic syncope despite conservative therapies. The primary efficacy endpoint was freedom from syncope during follow up. Any procedure-related adverse events (AE) were also assessed. 162 patients (CNA [n=61], PM [n=101]) with age 36+11 years (64 % female) and syncope frequency of 6.7±3.9/year were included. In patients undergoing CNA, age (35 + 12 vs 36 + 11, p =0.581) and pre-procedure syncope frequency [median 5 (IQR 4-8) vs median 6 (IQR (4-10), p = 0.52) were similar, and proportion of women lesser compared to the PM group (40.9% vs 77.2%, p <0.001). At 1-year, 96.7% (59/61) and 89.1% (90/101) met primary efficacy endpoint in the CNA and PM groups (unadjusted HR=0.30, 95% CI 0.07 - 1.34, p=0.119, p=NS, adjusted HR=0.27, 95% CI 0.06 - 1.24, p=0.09) (Figure 1). Major and minor AE occurred in 5/61 in the CNA and 11/101 in the cardiac pacing groups (p=0.79). In patients with CI-VVS, CNA demonstrated equivalent efficacy in reducing syncopal events when compared to cardiac pacing, with a similar safety profile.