Comparing Physical, Pharmacological, Pacemaker, and Cardioneuroablation Therapies for Patients with Vasovagal Syncope: A systematic review and network meta-analysis

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

IJC Heart and Vasculature Pub Date : 2026-04-01 Epub Date: 2026-02-10 DOI:10.1016/j.ijcha.2026.101885

Haozhe Wang , Yike Zhang , Siyi Liao , Hao Zhang , Xinmiao Huang

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引用次数: 0

Abstract

Background

Vasovagal syncope (VVS) represents the most frequent syncope subtype, but evidence comparing treatment strategies remains limited. This network meta-analysis (NMA) evaluates physical, pharmacological, pacemaker, and cardioneuroablation (CNA) therapies for VVS.

Methods

We conducted a Bayesian NMA of randomized controlled trials (RCTs) from PubMed, Embase, and Web of Science. The primary outcome was spontaneous syncope recurrence, and the secondary outcome was head-up tilt test (HUTT) positivity. Network geometry and treatment rankings were evaluated using Surface Under the Cumulative Ranking values.

Results

A total of 49 RCTs involving 2,798 patients assigned to various treatments were included. For spontaneous syncope recurrence, CNA [OR = 0.077, 95% CrI (0.015, 0.403)], pacing [OR = 0.075, 95% CrI (0.023, 0.22)], pharmacological [OR = 0.33, 95% CrI (0.11, 0.94)], and physical [OR = 0.27, 95% CrI (0.13, 0.57)] therapies were all superior to conventional therapy. Regarding HUTT outcomes, only pharmacological [OR = 5.5, 95% CrI (2.6, 12.0)] and physical [OR = 12, 95% CrI (2.9, 50.0)] therapies showed significant differences compared with placebo. Subgroup analysis identified dual-chamber pacing with closed-loop stimulation (DDD-CLS) as the highest-ranked therapy. Midodrine was the superior pharmacological option, and selective serotonin reuptake inhibitors demonstrated efficacy.

Conclusions

This NMA supports a stratified management approach for VVS. Physical and conventional therapies should be first-line. DDD-CLS pacing shows superior efficacy for cardioinhibitory VVS, while midodrine is the preferred pharmacological option. Although CNA demonstrates promise, it is constrained by limited direct evidence and should be considered hypothesis-generating, underscoring the need for head-to-head RCTs with long-term follow-up.

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比较血管迷走神经性晕厥患者的物理、药物、起搏器和心血管消融术治疗：系统综述和网络荟萃分析

迷走神经性晕厥（VVS）是最常见的晕厥亚型，但比较治疗策略的证据仍然有限。该网络荟萃分析（NMA）评估了VVS的物理、药理学、起搏器和心血管消融术（CNA）治疗。方法对来自PubMed、Embase和Web of Science的随机对照试验（RCTs）进行贝叶斯NMA分析。主要转归是自发性晕厥复发，次要转归是直立倾斜试验（HUTT）阳性。使用Surface Under Cumulative Ranking值评估网络几何形状和处理排名。结果共纳入49项随机对照试验，涉及2798例患者。对于自发性晕厥复发，CNA [OR = 0.077, 95% CrI(0.015, 0.403)]、起搏[OR = 0.075, 95% CrI(0.023, 0.22)]、药物治疗[OR = 0.33, 95% CrI(0.11, 0.94)]、物理治疗[OR = 0.27, 95% CrI(0.13, 0.57)]均优于常规治疗。在HUTT结局方面，只有药理学[OR = 5.5, 95% CrI(2.6, 12.0)]和物理[OR = 12, 95% CrI(2.9, 50.0)]治疗与安慰剂相比有显著差异。亚组分析确定双室起搏加闭环刺激（DDD-CLS）是排名最高的治疗方法。Midodrine是较好的药物选择，选择性血清素再摄取抑制剂显示出疗效。结论NMA支持VVS的分层管理方法。物理和常规治疗应该是第一线的。DDD-CLS起搏对心脏抑制性VVS有较好的疗效，而midodrine是首选药物。虽然CNA显示出了希望，但它受到有限的直接证据的限制，应该被认为是假设生成，强调需要长期随访的头对头随机对照试验。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

IJC Heart and Vasculature Medicine-Cardiology and Cardiovascular Medicine

CiteScore

4.90

自引率

10.30%

发文量

216

审稿时长

56 days

期刊介绍： IJC Heart & Vasculature is an online-only, open-access journal dedicated to publishing original articles and reviews (also Editorials and Letters to the Editor) which report on structural and functional cardiovascular pathology, with an emphasis on imaging and disease pathophysiology. Articles must be authentic, educational, clinically relevant, and original in their content and scientific approach. IJC Heart & Vasculature requires the highest standards of scientific integrity in order to promote reliable, reproducible and verifiable research findings. All authors are advised to consult the Principles of Ethical Publishing in the International Journal of Cardiology before submitting a manuscript. Submission of a manuscript to this journal gives the publisher the right to publish that paper if it is accepted. Manuscripts may be edited to improve clarity and expression.