Study population
We enrolled a cohort of forty-eight patients presenting with isolated neurocardiogenic syncope characterized by a pronounced cardioinhibitory component. Among them, 27 (56.3%) were female, and they had a documented history of recurrent syncope episodes (5.1±2.5 per year) causing significant impairment in their quality of life, despite prior attempts at clinical and pharmacological interventions. All patients received comprehensive information regarding available therapeutic options and elected to undergo CNA rather than pacemaker implantation.
Inclusion Criteria:
Patients were required to meet the following criteria:
  1. Diagnosis of neurocardiogenic syncope with a substantial cardioinhibitory component resulting in symptoms impacting quality of life;
  2. Age ranging from 15 to 70 years;
  3. Refractoriness, impracticality, or ineffectiveness of pharmacological treatment or pacemaker implantation;
  4. Willingness to provide written informed consent, participate in the study, and comply with the follow-up protocol.
Exclusion Criteria:
Those who meet any of the following criteria were not included:
1. Previous cardiac surgery.
2. Presence of cardiomyopathy (EF < 55%; LA > 42mm).
3. Left ventricular hypertrophy (wall thickness >1.2 cm), valvular, or coronary artery disease.
4. Contraindication for the use of anticoagulants (heparin or NOAC).
5. NYHA Heart Failure Class > I.
6. Cerebrovascular or important organic or metabolic disease.
8. Current or possible pregnancy in the next 3 months.