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Tilt-Test Outcomes After Cardioneuromodulation Across Two Vagal Phenotypes
Session:
Sessão de Posters 09 - Síncope, ILR e cardioneuromodulação
Speaker:
Felipe Souza Leão
Congress:
CPC 2026
Topic:
C. Arrhythmias and Device Therapy
Theme:
07. Syncope and Bradycardia
Subtheme:
07.4 Syncope and Bradycardia - Treatment
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
Felipe Leão; Tiago Constantino; Helena Fonseca; Sara Laginha; Helder Santos; Madalena Cruz; Guilherme Portugal; Paulo Osório; Ana Lousinha; Pedro Silva e Cunha; Bruno Valente; Mário Oliveira
Abstract
<p><span style="font-size:11.0pt"><span style="font-family:"Cambria",serif">Cardioneuromodulation (CNM) is increasingly used in patients with severe cardioinhibitory (CI) reflex syncope and hypervagotonic syndromes. Recent studies have shown that CNM can significantly reduce syncope burden in CI vasovagal syncope and may provide benefit in dedicated cohorts with symptomatic vagally mediated bradycardia as an alternative to cardiac pacing. We aimed to evaluate tilt test (TT) and clinical outcomes of CNM in hypervagotonic bradycardia (HB) and CI reflex syncope in a dedicated syncope unit.<br /> <br /> Methods: Consecutive patients undergoing CNM for severe recurrent CI syncope (CI group) or symptomatic HB (HB group) were included. Patients were classified according to clinical features and baseline investigations. TT performed before and after CNM were considered positive whenever there was reproduction of symptoms and a response not reported as negative. Outcomes included change in TT positivity and syncope recurrence during follow-up.<br /> <br /> Results: Fourteen patients were included (age 36.9 ± 8.5 years, 71.4% male): CI group – 6; HB group – 8. HB patients were younger and less frequently male (34.0 ± 7.1 years, 50.0%) compared with the CI group (40.8 ± 9.3 years, 100.0%; p = 0.085). Recurrent syncope pre-CNM was highly prevalent in both groups (87.5% vs 100%; p = 1.00). In the HB group, TT positivity decreased from 62.5% (5/8) to 12.5% (1/8), whereas in the CI group it decreased from 100% (6/6) to 66.7% (4/6; p = 0.091). Syncope recurrence occurred in two HB patients (25.0%) and in none of the CI patients during the first year of follow-up. No major procedural complications were documented.<br /> <br /> Conclusion: CNM was associated with a marked reduction in TT positivity across both HB and CI syncope phenotypes. HB patients demonstrated near-complete physiological conversion, while CI patients showed meaningful improvement with no recurrent syncope. These findings suggest that distinct vagal phenotypes may display differential physiological and clinical responses to CNM. Larger prospective studies are required to clarify the role of CNM within syncope management pathways.</span></span></p>
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