ArticleClinical cardiology2026
Empirical Anatomical Versus HAFE-Guided Cardioneuroablation for Vasovagal Syncope: Long-Term Efficacy and Safety Outcomes.
Article in Clinical cardiology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
BACKGROUND AND
aimsVasovagal 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.
methodsThis 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.
resultsNo 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.
conclusionsEAGC 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.
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