Simplified 3-ganglionated plexus ablation for the treatment of recurrent vasovagal syncope and functional bradyarrhythmia.

Abstract

Background: Cardioneuroablation (CNA) is an emerging treatment for recurrent vasovagal syncope (VVS), extrinsically mediated atrioventricular block (AVB), and sinus node dysfunction (SND). However, there is ongoing debate regarding the number of ganglionated plexuses (GPs) to ablate.

Objective: To evaluate differences in the degree of autonomic denervation and clinical outcomes between a simplified 3-GP ablation strategy and an extensive ablation approach.

Methods: This is a prospective, observational study of patients with recurrent VVS, extrinsic AVB, or SND. Patients were categorized into group A (3-GP ablation: right superior, left superior, and left posteromedial GP) and group B (additional GP ablation). Primary outcomes included relative heart rate (HR) increase after the atropine test at baseline and 6 months and syncope or pacemaker-free survival in the follow-up.

Results: Overall, 58 patients were included. There were no significant differences in the relative HR increase after the atropine test following CNA (A: 9.9% [4.1-19.0] vs B: 5.6% [2.8-8.4], P = .069) or at 6 months (A: 24.8% [15.0-37.2] vs B: 19.9% [16.8-25.4], P = .277). Similarly, after 19.1 (9.2-26.8) months there were no significant differences in syncope or pacemaker-free survival between groups (A: 15.2% vs B: 32.0%; log-rank P = .467). No significant differences were observed in most HR variability parameters or autonomic functional tests. Both groups showed a significant improvement in the SF-36 quality-of-life score (physical function p<.001, health change P < .001). Procedural time (P = .036) and fluoroscopy time (P = .015) were significantly shorter in the only 3-GP group.

Conclusion: A simplified 3-GP ablation strategy resulted in similar autonomic denervation and clinical outcomes compared with an extended ablation approach.