Clinical Electrophysiology -> Syncope & Bradycardia: -> Tilt Table Testing D-PO05 - Poster Session V (ID 39) Poster

D-PO05-221 - Benefit Of Cardioneuroablation To Reduce Syncope Recurrence In Cardioinhibitory Vasovagal Syncope Patients Selected With Head-up Tilt Test (ID 1314)


Background: Benefit of cardioneuroablation (CNA) in patients with vasovagal syncope (VVS) and cardioinhibitory response to head-up tilt test (HUT) is still debated.
Objective: We sought to assess the medium-term effect of CNA vs medical therapy (MT) in a prospectively followed cohort in two institutions.
Methods: From 1/2009 to 9/2018, 2874 patients underwent HUT and 554 (19.2%) were reported as positive. A VASIS type 2B response during HUT was noted in 130 (23.4%) patients. A total of 101 cases between 18-65 years old were included in the final analysis (median age 39 [IQR 27-49] yrs, 62.4% male). 51patients (50.4%) underwent 3D mapping guided CNA and 51 (49.6%) received training on physical maneuvers and MT. The recurrence rate of syncope in the CNA cohort was compared with those on MT.
Results: During a median follow-up of 20 months (IQR 8-42 mo), syncope was seen in 12 (11.8%) cases. To reduce the risk of overfitting, propensity score was calculated from variables deemed to predict syncope during follow-up (age, sex, pre-enrollment total number of syncope, duration of asystole on HUT). The 60-month Kaplan-Meier syncope free-rate was 71% (CI, 46%-100%) in the CNA group and 62% (43%-90%) in the unmatched MT group, respectively. In propensity-matched patients, MT was significantly associated with syncope recurrence during follow-up (HR 10.7, 95% CI 2.44 - 47.4, p=0.0017). CNA was more effective than MT to prevent recurrent syncope regardless of baseline syncope burden (Figure 1).
Conclusion: In a VVS cohort with HUT-induced cardioinhibitory response, CNA was associated with a significant reduction in syncope recurrence during follow-up, when compared to conservative therapy.