SPC365

Cardioneuroablation in patients with hypervagotonia – an effective solution?

Session: SESSÃO DE POSTERS 55 - ARRITMOLOGIA: NOVOS DESAFIOS
Speaker: Margarida G. Figueiredo

Congress: CPC 2025
Topic: C. Arrhythmias and Device Therapy
Theme: 07. Syncope and Bradycardia
Subtheme: 07.4 Syncope and Bradycardia - Treatment
Session Type: Cartazes
FP Number: ---
Authors: Margarida G. Figueiredo; Sofia B. Paula; Sara Laginha; Helena Fonseca; Hélder Santos; Guilherme Portugal; Pedro Silva Cunha; Bruno Valente; Rui Ferreira; Mário Oliveira

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction: </strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Cardioneuroablation (CNA) is an ablation technique that targets epicardial ganglionic plexi to reduce syncope burden and avoid pacemaker implantation in young patients with cardioinhibitory vasovagal syncope (VVS). Although CNA has been used to treat VVS, it seems that this technique may have potential benefits in a variety of conditions mediated by hypervagotonia. </span></span></p>

<p style="text-align:justify">&nbsp;</p>

<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose:</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Our purpose was to evaluate the role of CNA in the treatment of conditions associated with or exacerbated by increased vagal tone such as VVS, functional atrioventricular block (AVB), and sinus node dysfunction (SND).</span></span></p>

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<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods: </strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Prospective single-centre study evaluating patients (P) who underwent CNA due to multiple AVB, SND or VVS, and their long-term follow-up in terms of symptoms or evidence of conduction disease. </span></span></p>

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<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results:</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">A total of 17 CNA were performed (15 P, two patients underwent a CNA redo procedure). Median follow-up was 13 (6 &ndash; 27) months - in 53% of P follow-up was performed through remote and clinic follow-up of their implantable loop recorders (ILR); in the remaining P, follow-up was performed with a 24h-Holter. 71% of P were male, mean age was 37&plusmn;10 years. 29% of P practiced high-intensity training in various modalities. 53% of P performed a tilt test before and after CNA. Before CNA 5 patients presented type 2B response, with 6, 19, 27, 45 and 90 second of asystole; 2 P had a negative result, 1 P had a type 2A response, 1 P presented classic orthostatic hypotension and 1 P presented postural orthostatic tachycardia syndrome. After CNA 5 P had a negative tilt test, 2 P had a type 1 response, 1 P had a type 2A response and 1 P had a type 3 response. Conduction system disease before CNA and in the long-term follow-up after CNA is described in table 1.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">The results in terms of heart rate and conduction disease immediately before and after CNA and symptomatology in the long-term follow-up are described in Table 2 and 3, respectively. Other symptoms mentioned in the table were mainly fatigue and dizziness.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Pacemaker was only implanted in 1 P with recurrent syncope episodes before and after CNA. There were 2 P with complications: 1 P had a pericardial tamponade during the procedure and pericardial drainage; the other complication was the migration of an ILR to the pleural space, causing complaints (mainly pleuritic pain) to the P.&nbsp; </span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Conclusion:</strong></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">In our study CNA showed to be a safe and efficient procedure in terms of treating symptoms (predominantly syncope) and conduction disease in P with conditions mediated by hypervagotonia. Larger studies are required to confirm these findings.</span></span></p>