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. 2025 Apr 4:19:1514513.
doi: 10.3389/fnins.2025.1514513. eCollection 2025.

Efficacy of cardioneuroablation for vasodepressor vasovagal syncope

Zhenhuan Chen #  1 , Ying Li #  1   2 , Yuan Liu  1 , Guowang Shen  1 , Ganwei Xiong  1 , Bo Wu  1 , Yanfeng Liu  1 , Xiantao Huang  1 , Hongyan Li  1 , Haiwen Zhou  1 , Zhicheng Xu  1 , Gulao Zhang  1 , Yu Tao  1 , Fanzhi Zhang  1 , Hengli Lai  1
Affiliations

Efficacy of cardioneuroablation for vasodepressor vasovagal syncope

Zhenhuan Chen et al. Front Neurosci. .

Abstract

Objective: Cardioneuroablation (CNA) is effective for cardiac inhibitory and mixed vasovagal syncope (VVS) but not for vasodepressor VVS. This study aimed to assess the therapeutic benefits of CNA in vasodepressor VVS.

Methods: VVS patients hospitalized in the Department of Cardiology of Jiangxi Provincial People's Hospital were retrospectively reviewed. Holter monitoring was performed before, during, and 3 months after CNA. Changes in heart rate and atrioventricular conduction before and after ablation were compared.

Results: Thirty-five patients (18 M/17F, 47.48 ± 16.49 years) were included. Median duration of syncope was 24.0 months (range, 2.5-66.0). Median number of syncope episodes before treatment was two (range, 2-4). The time domain indexes of heart rate variability, mean heart rate, maximum heart rate, and minimum heart rate were significantly higher 3 months after CNA. Mean follow-up was 11 ± 4.67 months. Recurrent syncope occurred in two patients with vasodepressor VVS, one of them with presyncope symptoms in vasodepressor type; and one patient occurred with mixed VVS, without presyncope symptoms. The syncope free survival is 76.92%. No serious complications occurred. CNA is safe and effective in the treatment of vasodepressor VVS.

Conclusion: CNA is effective for treating vasodepressor VVS. Our study provides a theoretical basis for individualization of treatment in patients with vasodepressor VVS.

Keywords: heart rate variability; high frequency stimulation; left atrial vagal plexus; radiofrequency ablation; vasovagal syncope.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Schematic representation of the distribution of the autonomic ganglionated plexus in the left atrium of a patient with mixed VVS. The left superior GP (LSGP) is located at the anterolateral junction of the left superior pulmonary vein and left atrium. The left inferior GP (LIGP) is located in the posterior inferior region of the junction between the left inferior pulmonary vein and the left atrium. The posteromedial left GP (PMLGP) is in the posterior atrial septum, between the left atrial posterior wall, inferior vena cava, and coronary sinus opening. The right anterior GP (RAGP) is in the anterior region of the junction between the right superior pulmonary vein and the left atrium. The right inferior GP (RIGP) is in the anterior region of the junction between the right inferior pulmonary vein and the left atrium (Left, posterior anterior position of heart; Right, anteroposterior position of heart).
Figure 2
Figure 2
Schematic representation of the distribution of the autonomic ganglionated plexus in the left atrium of a patient with vasodepressor VVS. The left superior GP (LSGP) is located at the anterolateral junction of the left superior pulmonary vein and left atrium. The left inferior GP (LIGP) is located in the posterior inferior region of the junction between the left inferior pulmonary vein and the left atrium. The posteromedial left GP (PMLGP) is in the posterior atrial septum, between the left atrial posterior wall, inferior vena cava, and coronary sinus opening. The right anterior GP (RAGP) is in the anterior region of the junction between the right superior pulmonary vein and the left atrium. The right inferior GP (RIGP) is in the anterior region of the junction between the right inferior pulmonary vein and the left atrium (Left, posterior anterior position of heart; Right, anteroposterior position of heart).
Figure 3
Figure 3
Schematic representation of cardiac ganglionated plexus ablation in a patient with VVS. Illustration of the vagal response induced by radiofrequency energy delivery at the RIGP. The geometry of the left atrium was constructed using the Ensite Navx mapping system. The blue balls represent the ablated lesions with a positive vagal response at each GP site. The green dots represent the real-time shadow of the catheter tip on the left atrial geometry. Radiofrequency ablation at the LSGP induced sinus arrest lasting 2,400 ms.
Figure 4
Figure 4
Comparison of the frequency of positive vagal reaction during GPs ablation. In both mixed and vasodepressor VVS, vagal responses were most frequently observed at the LSGP and RAGP.
Figure 5
Figure 5
Kaplan–Meier curve of recurrent syncope in patients with Vascular inhibitory and mixed VVS after CNA.
See this image and copyright information in PMC

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