Key result
Cardioneuroablation abolished symptoms in more than 75% of patients with malignant cardioinhibitory syncope, with a 13.3% overall syncope recurrence rate over a mean follow-up of 38 months.
Why the study?
Refractory malignant cardioinhibitory syncope has traditionally been treated with pacemaker implantation, which has questionable results and is highly rejected by young patients.
Does cardioneuroablation improve symptoms in patients with malignant cardioinhibitory syncope?
Cohort (n=75)
Does cardioneuroablation improve symptoms in patients with malignant cardioinhibitory syncope?
Absolute Event Rate: 13.3% vs 28%
Cardioneuroablation appears to be an effective therapeutic option for malignant cardioinhibitory syncope, abolishing symptoms in a majority of patients and potentially avoiding the need for pacemaker implantation.
Hypothesis-generating for cardioneuroablation in refractory cardioinhibitory syncope; randomized trials needed before practice change.
The vasovagal syncope is the most frequent cause of transient loss of consciousness, especially in young people without significant heart disease. The malignant cardioinhibitory form is caused by abrupt and intense vagal reflex with or without defined triggers. Refractory cases to preventive measures and pharmacological handling has been treated with definitive pacemaker implantation. Besides showing questionable results, pacemaker implantation is highly rejected by young patients. In the late 1990s, we proposed specific vagal denervation by catheter ablation and spectral mapping, for paroxysmal AF, functional bradyarrhythmias and severe cases of malignant cardioinhibitory syncope giving rise to cardioneuroablation. Recently, many authors worldwide have been reproducing the cardioneuroablation results where elimination or significant reduction of the vagal response were observed, which abolished symptoms in more than 75% of patients followed up to 14 years, without complications. Therefore, cardioneuroablation has shown to be a real therapeutic option in malignant syncope cardioinhibitory and in any exclusive vagal mediated bradyarrhythmia without the need for pacemaker implantation.
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Mateos et al. (2020) conducted a cohort in Cardioinhibitory Syncope (n=75). Cardioneuroablation (Catheter Vagal Denervation) vs. Clinical treatment or pacemaker (historical controls) was evaluated on Syncope recurrence (indeterminate plus vasodepressor). Cardioneuroablation abolished symptoms in more than 75% of patients with malignant cardioinhibitory syncope, with a 13.3% overall syncope recurrence rate over a mean follow-up of 38 months.
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