Effects of cardioneuroablation for vasovagal syncope: ganglionated plexus localization by tentative anatomical ablation and high-frequency electrical stimulation.

BACKGROUND

Cardioneuroablation is increasingly being adopted as a treatment for vasovagal syncope (VVS). Identification of the cardiac ganglionated plexus (GP) is a critical factor influencing the outcome of the procedure. This study sought to compare the efficacy of tentative anatomical ablation (TAA) and high-frequency electrical stimulation (HFS) in locating the GP.

METHODS

A total of 58 patients diagnosed with VVS were consecutively enrolled, including 46 patients with the cardioinhibitory type and 12 patients with the mixed type who exhibited a significant decrease in heart rate (HR). The first 19 enrolled patients simultaneously underwent HFS- and TAA-guided GP localization. All patients underwent anatomical GP ablation.

RESULTS

The number of GP sites with a positive response to TAA was significantly greater than those from HFS (15 ± 4 per person vs. 12 ± 4 per person; p < 0.001). Following anatomical ablation, the patients exhibited an increase in HR (69 ± 13 bpm vs. 91 ± 13 bpm, p < 0.001), a reduction in sinus node recovery time (1155 ± 169 ms vs. 934 ± 162 ms, p < 0.001), an enhancement of atrioventricular conduction (Wenckebach point: 418 ± 87 ms vs. 338 ± 41 ms; effective refractory period of atrioventricular node: 334 ± 84 ms vs. 254 ± 54 ms, all p < 0.001), and a reduction in heart rate variability (HRV) (HRV: 146 ± 64 ms vs. 67 ± 29 ms; high frequency: 309.18 ± 99.42 vs. 24.21 ± 12.73, all p < 0.001). During a median follow-up of 18 months, the rate of freedom from syncope recurrent was 94.8%, with no statistically significant differences observed in age, gender, or type of head-up tilt test.

CONCLUSIONS

In GP localization, TAA-guided responses demonstrated greater precision and wider distribution compared to HFS-guided approaches. Anatomical GP ablation can significantly decrease autonomic tone and prevent syncope in patients with VVS.

CLINICAL TRIAL NUMBER

Not applicable.