Cardioneuroablation in patients with reflex syncope and parasympathicotonic bradyarrhythmias: long-term results
A Bulava, K Staskova, M Bobosik, D Sitek, J TesarikAbstract
Introduction
Cardioneuroablation (CNA) has over time become an established treatment for reflex syncope with a predominance of bradycardia and for other symptomatic bradycardias (sinus arrest, sinus bradycardia, or paroxysmal complete AV block). The aim of our report is to present long-term follow-up results of patients after CNA in this mixed population.
Methods and results
Over the past 8 years, 83 CNAs were performed at our cardiology center in a total of 80 patients (66% male, mean age 41 ± 13 years) with the current follow-up exceeding 3 years. Fifty-three of them (67%) underwent CNA for recurrent syncope; the remaining patients had presyncopal states (15%) and/or symptomatic bradycardias (62%). Thirty-five patients (44%) were treated for documented vasovagal syncope (VVS) with a positive head-up tilt test (HUTT), and 5 patients (6%) for carotid sinus hypersensitivity syndrome. Mean procedure duration was 67 ± 21 minutes (fluoroscopy time 6.1 ± 3.1 minutes, fluoroscopy dose 3788 ± 2515 mGy·cm2). Heart rate increased from 55 ± 10/min to 83 ± 13/min (p < 0.001), AH interval shortened from 102 ± 50 ms to 78 ± 30 ms (p < 0.001), and the Wenckebach point increased from 143 ± 40/min to 171 ± 14/min (p < 0.001). No significant acute complications were recorded. Absence of syncope or need for permanent cardiac pacing was observed in 76 patients (95%) and 78 patients (97%) during a follow-up of 4.9 ± 1.7 years (median 4.7 years) after the first and repeated procedures, respectively. However, 8 patients and 5 patients experienced presyncopal spells after the first and repeated procedures, respectively.
Conclusion
CNA is the treatment of choice for younger patients with reflex syncope or symptomatic functional bradycardias, with excellent outcomes and a very good safety profile.