Cardioneuroablation for the treatment of vasovagal syncope, functional sinus node dysfunction and functional atrioventricular block: initial experience in one center

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Background and purpose Cardioneuroablation (CNA) or ablation of the ganglionated plexi (GP) is an emergent procedure that has been used in the treatment of vasovagal syncope (VVS), functional sinus node dysfunction (SND) and functional atrioventricular block (AVB). The aim of the present study was to describe our initial experience with this technique. Methods Prospective, unicentric, observational study of consecutive patients which were referred to our institution for VVS, functional SND or functional AVB. Prior the procedure, all the patients underwent atropine test. Results A total of 19 patients were included in the study (51.5 ± 12.7 years, 68.4% males). 15 patients (78.9%) had prior syncope with a median of 1.6 ± 3.8 episodes per month. 8 patients (42.1%) underwent the procedure due to recurrent VVS, 6 patients (31.6%) due to SND and 5 patients (26.3%) due to AVB. Prior the procedure there was an increase of 39 ± 8% of the heart rate (HR) with the atropine test. Extracardiac vagal stimulation, was attempted in 11 patients (59.7%) and from them, only 63.6% had vagal responses. We used an anatomic approach in 79% of the patients. The right superior GP was ablated with a bi-atrial approach in 100% of the patients. At the end of the procedure all the patients had a negative atropine test with an increase in the HR significantly lower than prior the procedure (39 ± 8% vs 5 ± 5%; p=0.002). After a median follow-up of 8.5 (3.9-17.7) months, freedom from syncope was 93.3% and the incidence decrease from 1.6 ± 3.8 to 0.02 ± 0.11 episodes per month. Freedom from pacemaker implantation was 88.8%. There was a significant reduction in the patients who experience presyncope after the procedure (94.7% vs 21.1%; p=0.002) (Figure 1). No complications were observed related to the procedure. Conclusions In our initial experience CNA could be a reasonable option for young patients with recurrent VVS, and functional SND or AVB, which could even be an alternative to pacemaker implantation. However more prospective and randomized studies are needed to support these conclusions.