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The benefit of cardioneuroablation to reduce syncope recurrence in vasovagal syncope patients: a case-control study

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Abstract

Background

Adequate and effective therapy for resistant vasovagal syncope patients is lacking and the benefit of cardioneuroablation (CNA) in this cohort is still debated. The aim of this study is to assess the long-term effect of CNA versus conservative therapy (CT) in a retrospectively followed cohort.

Methods

A total of 2874 patients underwent head-up tilt test (HUT) and 554 (19.2 %) were reported as positive, with VASIS type 2B response or > 3 s asystole in 130 patients. After exclusion of 29 patients under 18 years and over 65 years of age, 101 patients were included final analysis. Fifty-one patients (50.4%) underwent CNA and 50 (49.6%) patients received CT. After propensity score matching, 19 pairs of patients were successfully matched. The recurrence rate of syncope was compared between groups.

Results

During a median follow-up of 22 months (IQR, 13–35), syncope was seen in 12 (11.8%) cases. In the 19 propensity-matched patients, recurrent syncope was observed in 8 patients in the CT group and in 2 patients in the CNA group, respectively. In mixed effect Cox regression analysis, CNA was associated with less syncope recurrence risk at follow-up (HR 0.23, 95% CI 0.03–0.99, p = 0.049). The 4-year Kaplan-Meier syncope free rate was 0.86 (95% CI, 0.63–1.00) for CNA group and 0.50 (95% CI, 0.30-0.82) for CT group in the matched cohort.

Conclusions

In highly selected patients with HUT-induced cardioinhibitory response, CNA is associated with a significant reduction in syncope recurrence during follow-up when compared to CT.

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Data availability

The data underlying this article will be shared on reasonable request to the corresponding author.

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Authors and Affiliations

  1. Department of Cardiology, Kocaeli Derince Education and Research Hospital, University of Health Sciences, 41500 Derince, Kocaeli, Turkey

    Tolga Aksu, Tumer Erdem Guler & Serdar Bozyel

  2. Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India

    Deepak Padmanabhan, Jayaprakash Shenthar & Bharat Banavalikar

  3. Faculty of Medicine, Department of Cardiology, Istanbul University-Cerrahpasa, Istanbul, Turkey

    Kivanc Yalin

  4. Division of Cardiovascular Medicine, University of Missouri-Columbia, Columbia, MO, USA

    Sandeep Gautam

  5. Department of Cardiology, Government Medical College, Thiruvananthapuram, India

    Sanjai Pattu Valappil

  6. Department of Cardiology, Nisantasi University & Hisar Intercontinental Hospital, Istanbul, Turkey

    Ibrahim Halil Tanboga

  7. Department of Biostatistics, Medical School, Ataturk University, Erzurum, Turkey

    Ibrahim Halil Tanboga

  8. Kansas City Heart Rhythm Institute and Research Foundation, Overland Park, KS, USA

    Dhanunjaya Lakkireddy & Rakesh Gopinathannair

  9. University of Iowa Hospitals and Clinics, Iowa City, IA, USA

    R. Brian Olshansky

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  1. Tolga Aksu
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  2. Deepak Padmanabhan
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Correspondence to Tolga Aksu.

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Aksu, T., Padmanabhan, D., Shenthar, J. et al. The benefit of cardioneuroablation to reduce syncope recurrence in vasovagal syncope patients: a case-control study. J Interv Card Electrophysiol 63, 77–86 (2022). https://doi.org/10.1007/s10840-020-00938-0

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  • DOI: https://doi.org/10.1007/s10840-020-00938-0

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