Key result
Cardioneuroablation yields ~90% freedom from vasovagal syncope recurrence in patients under 40 with frequent episodes.
Why the study?
Despite increasing use of cardioneuroablation for vagally mediated bradyarrhythmias, controversial issues persist regarding patient selection, safety and efficacy, and procedural end-points.
Does cardioneuroablation improve outcomes in patients with vagally mediated bradyarrhythmias?
Does cardioneuroablation improve outcomes in patients with vagally mediated bradyarrhythmias?
Answers are grounded in this paper and cite their sources.
Cardioneuroablation shows promise for treating vagally mediated bradyarrhythmias and vasovagal syncope, particularly in patients <40 years old with cardioinhibitory or mixed VVS, though sham-controlled trials are needed to quantify placebo effects.
INTRODUCTION: Cardioneuroablation is increasingly being utilized to improve outcomes in patients with vagally mediated bradyarrhythmias. However, there are still controversial issues in the field including patient selection, safety and efficacy, and procedural end-points. AREAS COVERED: In this review, the current role of cardioneuroablation is summarized, and controversial issues related to the modality are discussed. EXPERT OPINION: According to small open-label cohort studies, overall freedom from syncope recurrence was higher than 90% after cardioneuroablation in patients with vasovagal syncope (VVS). Use of the electrogram-based strategy or high-frequency stimulation demonstrate similar success rate except in procedures limited to the right atrium. Based on a recently published randomized controlled trial and metanalysis, it may be possible now to make a strong recommendation for cardioneuroablation in patients <40 years of age, and those with the cardioinhibitory or mixed type of VVS who continue to experience frequent and/or burdensome syncope recurrences. Considering patients with VVS are prone to significant placebo/expectation effect, sham-controlled trials may help to quantify the placebo effect. In well-selected patients with functional atrioventricular block and sinus bradycardia, may result in encouraging medium-term outcomes. However, functional bradycardia is identified in a minority of patients presenting with high-grade atrioventricular block or sinus node dysfunction.
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Aksu et al. (2022) conducted a review in Vagally mediated bradyarrhythmias and vasovagal syncope. Cardioneuroablation was evaluated. Cardioneuroablation yields >90% freedom from syncope recurrence in vasovagal syncope and is recommended for patients <40 years with frequent cardioinhibitory or mixed type recurrences.
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