Tolga Aksu1, Deepak Padmanabhan2, Jayaprakash Shenthar2, Kivanc Yalin3, Sandeep Gautam4, Sanjai Pattu Valappil5, Bharat Banavalikar2, Tumer Erdem Guler6, Serdar Bozyel6, Ibrahim Halil Tanboga7,8, Dhanunjaya Lakkireddy9, R Brian Olshansky10, Rakesh Gopinathannair9. 1. Department of Cardiology, Kocaeli Derince Education and Research Hospital, University of Health Sciences, 41500 Derince, Kocaeli, Turkey. aksutolga@gmail.com. 2. Sri Jayadeva Institute of Cardiovascular Sciences and Research, Bangalore, India. 3. Faculty of Medicine, Department of Cardiology, Istanbul University-Cerrahpasa, Istanbul, Turkey. 4. Division of Cardiovascular Medicine, University of Missouri-Columbia, Columbia, MO, USA. 5. Department of Cardiology, Government Medical College, Thiruvananthapuram, India. 6. Department of Cardiology, Kocaeli Derince Education and Research Hospital, University of Health Sciences, 41500 Derince, Kocaeli, Turkey. 7. Department of Cardiology, Nisantasi University & Hisar Intercontinental Hospital, Istanbul, Turkey. 8. Department of Biostatistics, Medical School, Ataturk University, Erzurum, Turkey. 9. Kansas City Heart Rhythm Institute and Research Foundation, Overland Park, KS, USA. 10. University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
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.
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.