Clinical impact of aging on outcomes of cardioneuroablation for reflex syncope or functional bradycardia. Results from the cardionEuroabLation: patiEnt selection, imaGe integrAtioN and outComEs. The ELEGANCE multicenter study

Background: Cardioneuroablation (CNA) is a novel treatment for reflex syncope. The effect of aging on CNA efficacy is not fully understood. Objective: We assessed the impact of aging on candidacy and efficacy of CNA for treating vasovagal syncope (VVS), carotid sinus syndrome (CSS) and functional bradyarrhythmia. Methods: The ELEGANCE multicenter study assessed CNA in patients with reflex syncope or severe functional bradyarrhythmia. Patients underwent pre-CNA Holter ECG, head-up tilt testing (HUT) and electrophysiologic study. CNA candidacy and efficacy was assessed in 14 young (18-40 years), 26 middle-aged (41-60 years) and 20 older (>60 years) patients. Results: Sixty patients (37 men; mean age: 51±16 years) underwent CNA. The majority (80%) had VVS, 8% CSS, and 12% functional bradycardia/AV block. Pre-CNA Holter ECG, HUT and EP findings did not differ across age groups. Acute CNA success was 93%, without differences between age groups (p=0.42). Post-CNA HUT response was negative in 53%, vasodepressor in 38%, cardioinhibitory in 7% and mixed in 2%, without differences across age groups (p=0.59). At follow-up (8 months, IQR:4-15), 53 (88%) patients were free of symptoms. Kaplan-Meier curves did not show differences in event-free survival between age groups (p=0.29). The negative predictive value of a negative HUT was 91.7%. Conclusions: CNA is a viable treatment for reflex syncope and functional bradyarrhythmia in all ages, and is highly effective in mixed VVS. HUT is a key-step of post-ablation clinical assessment.