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. 2022 Sep 13;11(18):5371.
doi: 10.3390/jcm11185371.

Clinical Efficacy of Catheter Ablation in the Treatment of Vasovagal Syncope

Lingping Xu  1   2 , Yixin Zhao  3 , Yichao Duan  2 , Rui Wang  2 , Junlong Hou  2 , Jing Wang  2 , Bin Chen  2 , Ye Yang  2 , Xianjun Xue  2 , Yongyong Zhao  2 , Bo Zhang  2 , Chaofeng Sun  1 , Fengwei Guo  4
Affiliations

Clinical Efficacy of Catheter Ablation in the Treatment of Vasovagal Syncope

Lingping Xu et al. J Clin Med. .

Abstract

Catheter ablation of ganglionated plexi (GPs) performed as cardioneuroablation in the left atrium (LA) has been reported previously as a treatment for vasovagal syncope (VVS). However, the efficacy and safety of catheter ablation in the treatment of VVS remains unclear. The objective of this study is to explore the efficacy and safety of catheter ablation in the treatment of VVS and to compare the different ganglion-mapping methods for prognostic effects. A total of 108 patients with refractory VVS who underwent catheter ablation were retrospectively enrolled. Patients preferred to use high-frequency stimulation (HFS) (n = 66), and anatomic landmark (n = 42) targeting is used when HFS failed to induce a positive reaction. The efficacy of the treatment is evaluated by comparing the location and probability of the intraoperative vagal reflex, the remission rate of postoperative syncope symptoms, and the rate of negative head-up tilt (HUT) results. Adverse events are analyzed, and safety is evaluated. After follow-up for 8 (5, 15) months, both HFS mapping and anatomical ablation can effectively improve the syncope symptoms in VVS patients, and 83.7% of patients no longer experienced syncope (<0.001). Both approaches to catheter ablation in the treatment of VVS effectively inhibit the recurrence of VVS; they are safe and effective. Therefore, catheter ablation can be used as a treatment option for patients with symptomatic VVS.

Keywords: catheter ablation; ganglionated plexus; high-frequency stimulation; syncope; vasovagal syncope.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Distribution of GP. (a) High-frequency stimulation group. The green dots represent positive spots. The blood pressure and heart rate decreased significantly during high-frequency stimulation, which was widely distributed in the pulmonary vein vestibule. The white dots are negative spots; the heart rate and blood pressure did not change significantly during stimulation. The red dots represent cardiac arrest for >4 s at the time of stimulation. (b) Anatomical group. The green points are positive reaction points for anterior wall GP ablation, the yellow points are positive reaction points for posterior wall GP ablation, and the white and blue points are negative points.
Figure 2
Figure 2
Distribution of ablation sites for anatomic ablation: LSG, RAGP, LIGP, RIGP, and CSMGP.
Figure 3
Figure 3
Ventricular arrest induced by high-frequency stimulation. (a) Upper left GPHFS induced 5251 ms of asystole. (b) Right anterior GPHFS induced 4350 ms of asystole.
Figure 4
Figure 4
(a) During RAGP ablation, the heart rate decreased, the temporary pacemaker started pacing below the set frequency, and ablation continued until the positive reaction disappeared. (b) Repeated high-frequency stimulation verification after ablation showed no heart rate decline, reaching the ablation endpoint.
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