A novel strategy to treat vaso-vagal syncope: Cardiac neuromodulation by cryoballoon pulmonary vein isolation

Background: Clinical management of vaso-vagal syncope (VVS) remains challenging since no therapy has proven to completely prevent VVS recurrence. Objective: The purpose of this study was to analyze the mid-term outcome of cryoballoon (CB) cardioneuroablation achieved by pulmonary vein isolation (PVI...

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Bibliographic Details
Published in:Indian Pacing and Electrophysiology Journal
Main Authors: Riccardo Maj, Thiago Guimarães Osório, Gianluca Borio, Saverio Iacopino, Erwin Ströker, Juan Sieira, Muryo Terasawa, Shuichiro Kazawa, Alessandro Rizzo, Alessio Galli, Varnavas Varnavas, Gezim Bala, Xavier Galloo, Gaetano Paparella, Pedro Brugada, Yves De Greef, Carlo De Asmundis, Gian Battista Chierchia
Format: Article in Journal/Newspaper
Language:English
Published: Elsevier 2020
Subjects:
Cryoballon
Cardioneuromodulation
Cryoballon ablation
Vasovagal syncope
Autonomics
Diseases of the circulatory (Cardiovascular) system
RC666-701
Arctic
Online Access:https://doi.org/10.1016/j.ipej.2020.03.008
https://doaj.org/article/fa24efbde7634267bb7b2e92c82d3dd3
Description
Summary:Background: Clinical management of vaso-vagal syncope (VVS) remains challenging since no therapy has proven to completely prevent VVS recurrence. Objective: The purpose of this study was to analyze the mid-term outcome of cryoballoon (CB) cardioneuroablation achieved by pulmonary vein isolation (PVI) in patients with VVS. Methods: Patients who underwent CB cardioneuroablation in our centers between January 2014 to June 2018 were included. All patients had a history of VVS or pre-syncope despite therapeutic attempts with medical and/or pacing treatments. Patients were excluded in case of structural heart diseases, cerebrovascular diseases or suspected drug-related syncope. Both heart rate (HR) and atrio-ventricular (AV) interval were analyzed on the 12-lead electrocardiogram (ECG) the day before the procedure, the day after, and in the follow-up. Results: In total, 26 patients (76.9% males, 37.5 ± 9.0 years old) were included. All patients underwent a successful procedure with the 28 mm second-generation Arctic Front Advance CB. No major complication occurred. At a mean follow-up of 20.1 ± 11.6 months the freedom from VVS or reflex pre-syncope was 83,7%, with 22 patients free from any clinical recurrence. Basal HR significantly increased the day after the procedure (57.2 bpm vs 78.3 bpm, p < 0.001), while at the final follow-up it stabilized at a value halfway between the 2 previous ones (69.8 bpm, p = 0.0086). The AV interval didn’t modify significantly after the procedure. Conclusion: Endocardial autonomic denervation achieved by CB PVI appears to be an effective and safe treatment option for patients with refractory VVS and reflex pre-syncope.

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