Cardioneuroablation in patients with vasovagal syncope: An updated systematic review and meta-analysis

Abstract

Background: Cardioneuroablation (CNA) is a novel procedure that shows promising results in reducing syncope recurrence in patients with refractory vasovagal syncope (VVS). However, its effectiveness and safety remain controversial.

Objective: We performed an updated meta-analysis evaluating CNA efficacy and safety in patients with refractory VVS.

Methods: PubMed, Embase, and Cochrane databases were systematically searched for CNA studies in patients with refractory VVS. Our primary efficacy end point was syncope recurrence, and our safety end point was periprocedural complications. Prespecified subgroup analyses were performed for (1) the ganglionated plexus (GP) targeting method and (2) the GP location of ablation.

Results: We included 27 observational studies and 1 randomized controlled trial encompassing 1153 patients with refractory VVS who underwent CNA. The median age was 39.6 years, and follow-up was 21.4 months. The overall weighted rate of syncope recurrence after CNA was 5.94% (95% confidence interval [CI] 3.37%-9.01%; I² = 64%), and the rate of periprocedural complications was 0.99% (95% CI 0.14%-2.33%; I² = 0%). Our prespecified subgroup analysis using the GP targeting method and GP ablation location showed a higher prevalence of syncope recurrence in the electroanatomic mapping subgroup (6.21%; 95% CI 2.93%-10.28%; I² = 0%) and in the right atrium approach (15.78%; 95% CI 3.61%-33.14%; I² = 65.2%).

Conclusion: This study supports the efficacy and safety of CNA in preventing syncope recurrence in patients with VVS. Furthermore, the electroanatomic mapping method of GP targeting and the right atrium approach were associated with a higher syncope recurrence rate than other methods.

Keywords: Cardioneuroablation; Ganglionated Plexi; Reflex syncope; Syncope recurrence; Vasovagal syncope.