HAFE-guided cardioneuroablation yielded comparable 24-month syncope-free survival to empirical anatomical-guided ablation (77.2% vs 85.6%; HR 1.648, 95% CI 0.648-4.194; p=0.285).
Cohort (n=109)
No
Does HAFE-guided cardioneuroablation improve 24-month syncope-free survival compared to empirical anatomical-guided cardioneuroablation in patients with refractory vasovagal syncope?
HAFE-guided cardioneuroablation offers similar 24-month syncope-free survival to empirical anatomical-guided ablation but significantly improves procedural efficiency with shorter procedure times and reduced radiation exposure.
Effect estimate: HR 1.648 (95% CI 0.648-4.194)
Absolute Event Rate: 77.2% vs 85.6%
p-value: p=0.285
ABSTRACT Background and Aims Vasovagal syncope (VVS) poses challenges despite therapy, and optimal cardioneuroablation (CNA) targeting ganglionated plexi (GPs) remains debated. This study compared long‐term efficacy and safety between empirical anatomical‐guided CNA (EAGC) and high‐amplitude fractionated electrogram (HAFE)‐guided CNA in patients with refractory VVS. Methods This single‐center retrospective analysis (July 2018 to July 2023) included 109 patients with refractory VVS undergoing CNA. Patients were divided into the EAGC group ( n = 70; empirical GP ablation at common anatomical sites) or the HAFE group ( n = 39; HAFE mapping‐guided GP ablation). The primary endpoint was 24‐month syncope‐free survival; secondary endpoints included procedural metrics, quality of life (QoL, via syncope dysfunction score SDS), and procedure‐related complications. Results No significant difference in 24‐month syncope‐free survival was observed between groups (HR = 1.648, 95% CI 0.648–4.194; log‐rank p = 0.285), with rates of 85.6% in the EAGC group and 77.2% in the HAFE group. The HAFE group demonstrated shorter procedure time (median 66.00 min IQR 52.00–87.50 vs. 90.00 min IQR 71.75–101.50; p < 0.001) and reduced radiation exposure (X‐ray dose: 6.00 IQR 4.17–10.75 mGy vs. 12.00 IQR 6.48–20.00 mGy; p = 0.002) and fluoroscopy time (2.53 IQR 1.92–4.06 min vs. 4.38 IQR 2.47–7.05 min; p < 0.001) compared to those in the EAGC group. Both groups exhibited significant reductions in syncope dysfunction score (SDS; p < 0.001), however, the intergroup difference in score reduction failed to reach statistical significance (ΔSDS; p = 0.487). Complication rates were comparable between two groups. Conclusions EAGC and HAFE‐guided CNA demonstrated comparable 24‑month syncope‑free survival with no significant difference in recurrence risk, while HAFE‐guided CNA improved procedural efficiency.
Zhang et al. (Fri,) conducted a cohort in Refractory vasovagal syncope (n=109). High-amplitude fractionated electrogram (HAFE)-guided cardioneuroablation vs. Empirical anatomical-guided cardioneuroablation (EAGC) was evaluated on 24-month syncope-free survival (HR 1.648, 95% CI 0.648-4.194, p=0.285). HAFE-guided cardioneuroablation yielded comparable 24-month syncope-free survival to empirical anatomical-guided ablation (77.2% vs 85.6%; HR 1.648, 95% CI 0.648-4.194; p=0.285).