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PO-01-324 CARDIONEUROABLATION FOR THE MANAGEMENT OF PATIENTS WITH RECURRENT VASOVAGAL SYNCOPE AND SYMPTOMATIC BRADYARRHYTHMIAS: INSIGHTS FROM THE INTERNATIONAL CNA-FWRD PROSPECTIVE REGISTRY
Abstract   Peer reviewed

PO-01-324 CARDIONEUROABLATION FOR THE MANAGEMENT OF PATIENTS WITH RECURRENT VASOVAGAL SYNCOPE AND SYMPTOMATIC BRADYARRHYTHMIAS: INSIGHTS FROM THE INTERNATIONAL CNA-FWRD PROSPECTIVE REGISTRY

Henry D. Huang, Jeanne du Fay de Lavallaz, Gurukripa N. Kowlgi, Piotr Futyma, Lukasz Zarebski, Tom De Potter, Michael Glikson, Moshe Rav Acha, Roin Rekvava, Sergio Conti, …
Heart rhythm, Vol.23(4 Supplement), pp.S334-S335
04/2026
DOI: 10.1016/j.hrthm.2026.03.1861

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Abstract

Introduction While interest in cardioneuroablation (CNA) for the treatment of cardioinhibitory vasovagal syncope and functional bradyarrhythmias is growing, prospective data with longitudinal follow-up remains limited Methods The international, multicenter CNA-FWRD registry included pts referred for consideration of CNA at 16 centers. Pts were prospectively enrolled and followed longitudinally; treatment exposure crossed over when CNA was performed. Primary endpoint was time to first occurrence of composite event (syncope, sinus pause, or AV block) documented by ECG, ambulatory monitor, or ILR. Events occurring the same date were deduplicated to 1 clinical episode. Time-to-first event was evaluated using Cox model with CNA as time-varying exposure and robust standard errors clustered by pt. Recurrent/cumulative event burden was evaluated using models accounting for person-time. Results The cohort included 318 pts (median age 36 YO [IQR 27–48], 49% female). Overall, 301(94.7%) underwent CNA and 17(5.3%) were managed conservatively only. Total follow-up was 4092 patient-months (median 9.9), with 1693 pt-months accrued pre-CNA and 2399 pt-months post-CNA. 58 composite clinical episodes occurred (39 pre-CNA, 19 post-CNA), corresponding to crude event rates of 2.30 and 0.79 per 100 pt-months, respectively. In time-to-first analyses with time-varying exposure, CNA was not associated with a statistically significant reduction in the primary composite endpoint (HR 0.73, 95% CI 0.27–1.95; p=0.53). In recurrent-event analyses, Andersen–Gill modeling showed a directionally lower hazard after CNA (HR 0.61, 95% CI 0.29–1.29; p=0.20), and event-rate modeling demonstrated a significantly lower composite event rate post-CNA (negative binomial IRR ≈0.29; p<0.001). Application In this international prospective registry, CNA was associated with lower observed composite event rates and significantly reduced recurrent-event burden. Time-to-first analyses were underpowered and did not show a statistically significant difference. Next Steps/Future Enrollment and acrual of patient follow up in the CNA-FWRD registry is ongoing. Larger studies with longer follow-up and robust control for residual confounding are needed to confirm clinical effectiveness of CNA.

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