Catheter Ablation as a Treatment for Vasovagal Syncope: Long‐Term Outcome of Endocardial Autonomic Modification of the Left Atrium

Abstract

BackgroundAutonomic modification through catheter ablation of ganglionated plexi (GPs) in the left atrium has been reported previously as a treatment for vasovagal syncope. This study aimed to observe the long‐term outcome in a larger cohort.Methods and ResultsA total of 57 consecutive patients (aged 43.2±13.4 years; 35 women) with refractory vasovagal syncope were enrolled, and high‐frequency stimulation and anatomically guided GP ablation were performed in 10 and 47 cases, respectively. A total of 127 GP sites with positive vagal response were successfully elicited and ablated, including 52 left superior, 19 left lateral, 18 left inferior, 27 right anterior, and 11 right inferior GPs. During follow‐up of 36.4±22.2 months (range 12–102 months), 52 patients (91.2%) remained free from syncope. Prodromes recurred in 16 patients. No statistical differences were found between the high‐frequency stimulation and anatomically guided ablation groups in either freedom from syncope (100% versus 89.4%, P=0.348) or recurrent prodromes (50% versus 76.6%, P=0.167). The deceleration capacity, heart rate, and heart rate variability measurements demonstrated a reduced vagal tone lasting for at least 12 months after the procedure, with improved tolerance of repeated head‐up tilt testing. No complications were observed except for transient sinus tachycardia that occurred in 1 patient.ConclusionsLeft atrial GP ablation showed excellent long‐term clinical outcomes and might be considered as a therapeutic option for patients with symptomatic vasovagal syncope.

Cardioneuroablation using an anatomical approach: a new and promising method for the treatment of cardioinhibitory neurocardiogenic syncope

“…Recently, endocardial biatrial ablation of ganglionated plexi (GP) has been shown to provide excellent short-and long-term results in the treatment of syncope caused by cardioinhibitory reflex syncope or functional AVB [2][3][4]. However, this method, called cardioneuroablation (CNA), is still evolving, and more data are needed to establish its role in the treatment of NMS.…”

Selective ablation of atrial ganglionated plexus attenuates vasovagal reflex in a canine model

“…As mentioned before, there are four major atrial GPs including ARGP, IRGP, SLGP, and ILGP . Ablation of these GPs were found to be effective in treating patients with vasovagal syncope, especially for patients with evident cardioinhibitory response . The rationale for GP ablation in the treatment of vasovagal syncope was considered to be the weakening of the efferent cardioinhibitory limb involved in vasovagal reflex through vagal denervation .…”

“…[10][11][12] Ablation of these GPs were found to be effective in treating patients with vasovagal syncope, especially for patients with evident cardioinhibitory response. [7][8][9] The rationale for GP ablation in the treatment of vasovagal syncope was considered to be the weakening of the efferent cardioinhibitory limb involved in vasovagal reflex through vagal denervation. 7 Since the vasodepressor element in vasovagal reflex is probably due to sympathetic inhibition, it is reasonable that GP ablation may not be effective for BP decrease in vasovagal reflex, which has been found in our results.…”

“…Later, Yao et al. and Sun et al used a high‐frequency stimulation‐guided technique to ablate four major atrial GPs in patients with vasovagal syncope and significantly improved the symptoms . Note that 91.2% of syncopal patients remained syncope‐free after an average follow‐up of 3 years …”

“…Pachon GPs in patients with vasovagal syncope and significantly improved the symptoms. 8,9 Note that 91.2% of syncopal patients remained syncopefree after an average follow-up of 3 years. 9 The rationale for GP ablation in treating vasovagal syncope is that it could weaken the efferent cardioinhibitory limb in the vasovagal reflex.…”