Heart rate variability and syncope free survival after endocardial ablation of ganlionated plexi in patiens with recurrent vasovagal syncope and functional sinus node dysfunction and AV block

Abstract

Abstract Introduction Cardioneuroablation (CNA) or ablation of the ganglionated plexi (GP) is an emergent procedure that has been used in the treatment of vasovagal syncope Conclusions: (VVS), functional sinus node dysfunction (SND) and functional atrioventricular block (AVB), however long term effects of this technique are not well defined. The aim of the present study was to describe our initial experience with this technique and to assess long term hear rate (HR) variability. 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 and 24-hour holter monitoring. Heart rate variability was assessed at 3 and 6 months with repeated 24-hour holter monitoring. Survival from syncope and pacemaker implantation was calculated in the cohort. Results 24 patients (52 ± 10 years, 70.8% males) were included in the study. 83.3% of the cohort had history of syncope (1.3 ± 3.4 episodes/month) and 95.8% of presyncope. Indication for CNA was SND 29.2%, AVB 25% and recurrent VVS in 45.8%. After a median follow up of 9.9 (4.3-20.7) months, 91.7% were free from syncope recurrence and only 29.2% had presyncope (p<0.001) (Figure 1). There was also a significant increase in minimum HR (p=0.01) and medium HR (p=0.02), without any differences in the maximum HR (p=NS). There was also a decrease in all the parameters used to assess HR variability (SDNN24 p=0.02; rMSSD p=0.017; pNN50 p<0.01) that was constant during the 6 months (Figure 2). Conclusions In our cohort, CNA was associated with a syncope free survival of 91.7% and could be a reasonable choice for patients with functional SND or AVB and recurrent VVS. There was an increase in the maximum and medium HR and a decrease in HR variability that remained constant at 6 months.Figure 1Figure 2