Catheter Ablation as a Treatment for Vasovagal Syncope: Long-Term Outcome of Endocardial Autonomic Modification of the Left Atrium

Methods and results: a total of 57 consecutive patients (aged 43.2±13.4 years; 35 women) with refractory vasovagal syncope were enrolled,and high-frequency stimulation and anatomically guided gp ablation were performed in 10 and 47 cases,respectively. a total of 127 gp sites with positive vagal response were successfully elicited and ablated,including 52 left superior,19 left lateral,18 left inferior,27 right anterior,and 11 right inferior gps. during follow-up of 36.4±22.2 months (range 12-102 months),52 patients (91.2%) remained free from syncope. prodromes recurred in 16 patients. no statistical differences were found between the high-frequency stimulation and anatomically guided ablation groups in either freedom from syncope (100% versus 89.4%,p=0.348) or recurrent prodromes (50% versus 76.6%,p=0.167). the deceleration capacity,heart rate,and heart rate variability measurements demonstrated a reduced vagal tone lasting for at least 12 months after the procedure,with improved tolerance of repeated head-up tilt testing. no complications were observed except for transient sinus tachycardia that occurred in 1 patient.conclusions: left atrial gp ablation showed excellent long-term clinical outcomes and might be considered as a therapeutic option for patients with symptomatic vasovagal syncope.background: autonomic modification through catheter ablation of ganglionated plexi (gps) in the left atrium has been reported previously as a treatment for vasovagal syncope. this study aimed to observe the long-term outcome in a larger cohort. © 2016 the authors. published on behalf of the american heart association,inc.,by wiley blackwell.