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Cardioneuroablation for vasovagal syncope: A systematic review and meta-analysis

  • Author Footnotes
    1 Dr Bert Vandenberk and Ms Lucy Y. Lei contributed equally.
    Bert Vandenberk
    Correspondence
    Address reprint requests and correspondence: Dr Bert Vandenberk, Libin Cardiovascular Institute, University of Calgary, Foothills Medical Centre, 1403–29 St NW, Calgary T2N 2T9, Alberta, Canada.
    Footnotes
    1 Dr Bert Vandenberk and Ms Lucy Y. Lei contributed equally.
    Affiliations
    Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

    Department of Cardiovascular Sciences, University of Leuven, Leuven, Belgium
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  • Author Footnotes
    1 Dr Bert Vandenberk and Ms Lucy Y. Lei contributed equally.
    Lucy Y. Lei
    Footnotes
    1 Dr Bert Vandenberk and Ms Lucy Y. Lei contributed equally.
    Affiliations
    Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
    Search for articles by this author
  • Brennan Ballantyne
    Affiliations
    Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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  • David Vickers
    Affiliations
    Mozell Core Analysis Lab, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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  • Zhiying Liang
    Affiliations
    Mozell Core Analysis Lab, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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  • Robert S. Sheldon
    Affiliations
    Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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  • Derek S. Chew
    Affiliations
    Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

    Duke Clinical Research Institute, Duke University, Durham, North Carolina
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  • Tolga Aksu
    Affiliations
    Yeditepe University Hospital, Department of Cardiology, Istanbul, Turkey
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  • Satish R. Raj
    Affiliations
    Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada

    Vanderbilt Autonomic Dysfunction Center, Division of Clinical Pharmacology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee
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  • Carlos A. Morillo
    Affiliations
    Department of Cardiac Sciences, Libin Cardiovascular Institute, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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  • Author Footnotes
    1 Dr Bert Vandenberk and Ms Lucy Y. Lei contributed equally.

      Background

      Cardioneuroablation (CNA) has emerged as promising therapy for patients with refractory vasovagal syncope (VVS).

      Objective

      The purpose of this study was to provide a freedom from syncope estimate for CNA, including subgroup analysis by method and target of ablation.

      Methods

      A systematic search was performed in MEDLINE and EMBASE according to the PRISMA guidelines until February 14, 2022. Observational studies and clinical trials reporting freedom from syncope were included. Meta-analysis was performed with a random-effects model.

      Results

      A total of 465 patients were included across 14 studies (mean age 39.8 ± 4.0 year; 53.5% female). Different techniques were used to guide CNA: 50 patients (10.8%) by mapping fractionated electrograms, 73 (15.7%) with the spectral method, 210 (45.2%) with high-frequency stimulation, 73 (15.7%) with a purely anatomically guided method, and 59 (12.6%) with a combination. The target was biatrial in 168 patients (36.1%), left atrium only in 259 (55.7%), and right atrium only in 38 (8.2%). The freedom from syncope was 91.9% (95% confidence interval [CI] 88.1%–94.6%; I2 = 6.9%; P = .376). CNA limited to right atrial ablation was associated with a significant lower freedom from syncope (81.5%; 95% CI 51.9%–94.7%; P <.0001) vs left atrial ablation only (94.0%; 95% CI 88.6%-–6.9%) and biatrial ablation (92.7%; 95% CI 86.8%–96.1%). Subgroup analysis according to the technique used to identify ganglionated plexi did not show any significant difference in freedom from syncope (P = .206).

      Conclusion

      This meta-analysis suggests a high freedom from syncope after CNA in VVS. Well-designed, double-blind, multicenter, sham-controlled randomized clinical trials are needed to provide evidence for future guidelines.

      Keywords

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