Cardioneuroablation demonstrated comparable syncope-free survival to closed-loop stimulation pacemaker therapy (89.2% vs 79.1%, HR 0.45) in patients over 40 years old with refractory cardioinhibitory vasovagal syncope.
Cohort (n=80)
No
Does cardioneuroablation with extracardiac vagal stimulation validation reduce syncope recurrence compared to dual-chamber pacemakers with closed-loop stimulation in patients > 40 years with refractory cardioinhibitory vasovagal syncope?
Cardioneuroablation with physiological validation demonstrates comparable efficacy and safety to dual-chamber pacemakers with closed-loop stimulation for preventing syncope recurrence in patients older than 40 years with refractory cardioinhibitory vasovagal syncope.
Effect estimate: HR 0.45 (95% CI 0.14-1.46)
Absolute Event Rate: 89.2% vs 79.1%
p-value: p=0.182
Refractory dominant cardioinhibitory vasovagal syncope (VVS) remains a therapeutic challenge in patients older than 40 years. Dual-chamber pacemakers with closed-loop stimulation (CLS-PM) are guideline-supported, while cardioneuroablation (CNA), targeting ganglionated plexus, has emerged as a device-free alternative. Direct comparative data between these strategies are limited. We conducted a retrospective, comparative cohort study including patients > 40 years with refractory cardioinhibitory VVS treated between 2018 and 2024. Patients underwent either CNA with extracardiac vagal stimulation validation (CNA-ECVS) or CLS-PM implantation. The primary outcome was recurrence of the first syncope episode. Secondary outcomes included syncope-free survival, syncope burden (≥ 50% reduction), and safety. Kaplan–Meier analysis and Cox proportional hazards models were applied. Eighty patients were included (37 CNA-ECVS, 43 CLS-PM; mean age 58.0 ± 14.6 years). Patients in the CNA group were younger than those in the CLS-PM group (49.9 ± 10.3 vs. 65.0 ± 14.1 years; p < 0.001). During a mean follow-up of 3.8 years, syncope-free rates were 89.2% in the CNA group and 79.1% in the CLS-PM group (p = 0.363). Syncope-free survival did not differ significantly (log-rank p = 0.168), and recurrence risk was similar between strategies (HR 0.45; 95% CI 0.14–1.46; p = 0.182). Post-procedural syncope burden was numerically lower after CNA (10.8% vs. 20.9%) but without statistical significance. No major adverse events were observed in either group. In patients older than 40 years with refractory cardioinhibitory NCS, CNA with physiological validation and CLS-PM therapy demonstrated comparable efficacy and safety. Both strategies represent viable therapeutic options, warranting confirmation in randomized clinical trials.
Álvarez-Ortiz et al. (Mon,) conducted a cohort in Refractory dominant cardioinhibitory vasovagal syncope (n=80). Cardioneuroablation with extracardiac vagal stimulation (CNA-ECVS) vs. Dual-chamber pacemaker with closed-loop stimulation (CLS-PM) was evaluated on Syncope-free survival (recurrence of the first syncope episode) (HR 0.45, 95% CI 0.14-1.46, p=0.182). Cardioneuroablation demonstrated comparable syncope-free survival to closed-loop stimulation pacemaker therapy (89.2% vs 79.1%, HR 0.45) in patients over 40 years old with refractory cardioinhibitory vasovagal syncope.