Effectiveness of cardioneuroablation in different subtypes of vasovagal syncopeOA

BACKGROUND Cardioneuroablation(CNA)has shown encouraging results in patients with vasovagal syncope(VVS).How-ever,data on different subtypes was scarce. METHODS This observational study retrospectively enrolled 141 patients[mean age:40±18 years,51 males(36.2％)]with the di-agnosis of VVS.The characteristics among different types of VVS and the outcomes after CNA were analyzed. RESULTS After a mean follow-up of 4.3±1.5 years,41 patients(29.1％)experienced syncope/pre-syncope events after CNA.Syn-cope/pre-syncope recurrence significantly differed in each subtype(P=0.04).The cardioinhibitory type of VVS had the lowest re-currence rate after the procedure(n=6,16.7％),followed by mixed(n=26,30.6％)and vasodepressive(n=9,45.0％).Additionally,a significant difference was observed in the analyses of the Kaplan-Meier survival curve(P=0.02).Syncope/pre-syncope burden was significantly reduced after CNA in the vasodepressive type(P＜0.01).Vasodepressive types with recurrent syncope/pre-syncope after CNA have a lower baseline deceleration capacity(DC)level than those without(7.4±1.0 ms vs.9.0±1.6 ms,P=0.01).Patie-nts with DC＜8.4 ms had an 8.1(HR=8.1,95％CI:2.2-30.0,P=0.02)times risk of syncope/pre-syncope recurrence after CNA com-pared to patients with DC ≥ 8.4 ms,and this association still existed after adjusting for age and sex(HR=8.1,95％CI:2.2-30.1,P=0.02). CONCLUSIONS Different subtypes exhibit different event-free rates.The vasodepressive type exhibited the lowest event-free rate,but those patients with DC ≥ 8.4 ms might benefit from CNA.