Cardioneuroablation reduces recurrent fainting, improves quality of life
Among adults with recurrent vasovagal syncope, cardioneuroablation was associated with a significant decrease in syncope recurrence and improvement in quality-of-life measures at 2 years compared with controls, researchers reported.
The findings were presented at the European Society of Cardiology Congress.
“Our study shows that cardioneuroablation is an effective and safe method for preventing asystolic vasovagal syncope,” Roman Piotrowski, MD, PhD, of the department of cardiology at the Centre of Postgraduate Medical Education at Grochowski Hospital, Warsaw, Poland, told Healio. “It is better than the standard approach of optimal nonpharmacological treatment and significantly improves quality of life.”
Prospective data
In a prospective, randomized controlled trial, Piotrowski and colleagues analyzed data from 48 adults with cardioinhibitory vasovagal syncope (17 men; mean age, 38 years) who underwent cardioneuroablation or optimal nonpharmacological treatment according to treatment guidelines.
“Our patients were very symptomatic, having on average 10 syncopal episodes in the past, including a mean of three syncopal episodes during [the] 1 year preceding the study,” the researchers wrote. “Also, their baseline quality of life was markedly reduced, reaching a mean of 30 to 31 points in the Impact of Syncope on Quality-of-Life Questionnaire University of Calgary. In all patients, nonpharmacological approaches consisting of avoiding situations triggering syncope, proper fluid intake, headboard elevation and physical maneuvers preventing syncope [were] ineffective.”
Researchers performed cardioneuroablation using radiofrequency ablation of the ganglionated plexi from the left and right atrium, with follow-up for 2 years. The primary endpoint was time to first syncope recurrence. Secondary endpoints included changes in sinus rhythm and heart rate variability measured at baseline and 3, 12 and 24 months, as well as changes in quality of life at baseline and after completion of follow-up.
The primary endpoint occurred in 8% of patients from the cardioneuroablation group and in 54% of controls at 2 years (P = .0004). After cardioneuroablation, the mean heart rate at 24-hour Holter ECG was significantly faster and heart rate variability parameters significantly changed towards parasympathetic withdrawal compared with baseline values, according to the researchers.
The findings were also published in JACC: Clinical Electrophysiology.
Quality of life ‘enormously improved’
Quality of life improved in the cardioneuroablation group between baseline and follow-up measurements (mean score, 30 at baseline vs. 10 at follow-up; P = .0001) but remained stable among controls (mean score, 31 at baseline vs. 30 at follow-up; P = .5501). There were no procedural complications.
“The cardioneuroablation enormously improved quality of life in our patients — they had three times lower score compared with baseline, whereas no change was observed in the control group,” the researchers wrote.
The researchers noted the cohort was small and that a placebo-like effect of cardioneuroablation “cannot be excluded” because the study was not blinded and the control group did not undergo a sham procedure. Additionally, the control group did not undergo Holter ECG recordings during follow-up and researchers could not compare cardioneuroablation-induced changes between the two groups.
“Cardioneuroablation may be considered in all patients with asystolic reflex syncope in whom nonpharmacological approaches failed,” Piotrowski told Healio. “It may prevent pacemaker implantation, especially in young patients, in whom permanent pacing is associated with serious complications during long-term follow-up.”
Retrospective data suggest cardioneuroablation may be a viable option for patients with recurrent syncope. As Healio previously reported, an analysis of data from procedures performed across 13 centers showed cardioneuroablation reduced symptoms of vasovagal syncope by as much as 80% for patients with symptoms despite medical intervention and behavioral modification who did not desire permanent pacing.
Reference:
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Piotrowski R, et al. Vasovagal syncope: New insights and improved interventions. Presented at: European Society of Cardiology Congress; Aug. 26-29, 2022; Barcelona, Spain (hybrid meeting).
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