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Brain & Heart Cardioneuroablation for VMB

sufficient data to calculate the effective rate; and (iv) no
restrictions on publication year, language, country, or
demographic details. Meanwhile, the exclusion criteria
included: (i) studies focusing solely on the immediate
response to CNA; (ii) animal studies; (iii) case reports;
(iv) studies with overlapping datasets; (v) studies with
unreliably extracted, duplicated, or incomplete data;
and (vi) articles available only as abstracts (conference
proceedings, letters, or commentaries). Full texts were
independently reviewed by two reviewers, and final decisions
regarding study inclusion were made through consensus.
3.1.3. Data extraction and quality assessment
Two investigators (F.H. and Y.W.) independently searched
for studies and extracted data using standardized
protocols and reporting forms. Any disagreements were
resolved through discussion with the author group until
a consensus was reached. The extracted data included the Figure 3. Flow diagram illustrates the selection process for articles.
publication year, methodology, sample demographics, PRISMA diagram illustrating the article selection process for inclusion
baseline characteristics, and follow-up information in the meta-analysis.
Abbreviations: PRISMA: Preferred reporting items for systemic reviews
(patients free from bradyarrhythmia-related symptoms, and meta-analyses.
patients requiring pacemaker implantation, and reported
complications). Quality assessment was independently 3.1.6. Statistical analysis
performed by two authors (M.Z. and G.L.) using the
Newcastle–Ottawa Scale (NOS) to assess the quality of all The statistical analysis was performed in accordance with
included studies. Discrepancies were resolved through the recommendations of the Cochrane Collaboration and
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discussion with the author group. Studies with a NOS score PRISMA guidelines. Data synthesis was performed using
of ≥6 stars were classified as moderate-to-high quality, the R package meta (The R Project for Statistical Computing,
while those with a score of <6 stars were classified as low Vienna, Austria). The I² statistic was used to assess study
quality. consistency, with values of 25%, 50%, and 75% indicating
low, moderate, and high heterogeneity, respectively. Funnel
3.1.4. Outcomes of meta-analysis plots were used for the graphical assessment of publication
bias. Sensitivity analyses were conducted by omitting one
The primary outcome was the absence of bradyarrhythmia- study at a time to evaluate the robustness of the results.
related symptoms (fatigue, dizziness, syncope, and pre-
syncope) during follow-up. The secondary outcomes 3.2. Results
were the proportion of patients requiring pacemaker
implantation and the incidence of complications observed 3.2.1. Freedom from bradyarrhythmia-related
during follow-up. symptoms
Nineteen studies involving 618 patients reported the effect
3.1.5. Study selection of CNA on the recurrence of bradyarrhythmia-related
As shown in Figure 3, the search strategy yielded 1,735 symptoms. As shown in Figure 4, 94.3% of the patients
studies. After removing 74 duplicates, 1,661 studies were (95% confidence interval [CI]: 90.9 – 97.7%, I² = 59%)
excluded based on screening of the title and abstract. were free from symptoms at the end of follow-up. Despite
The full texts of the remaining 67 studies were reviewed, moderate heterogeneity among the studies, the sensitivity
resulting in the exclusion of 48 studies. Ultimately, 19 analysis revealed that no individual study significantly
studies met the inclusion criteria and were included in the altered the overall results.
meta-analysis. 6,12,13,16,19,24-29,32-39 The general characteristics
and quality assessments of the included studies are 3.2.2. Proportion of pacemaker implantation after CNA
presented in Table 1. The observational studies had The need for pacemaker implantation following CNA was
NOS scores of 6 to 8 stars, indicating their suitability for analyzed in 464 patients from 12 studies. As shown in
analysis. Figure 5, 4.5% of the patients (95% CI: 2.6 – 6.4%, I² = 6%)

Volume 3 Issue 1 (2025) 4 doi: 10.36922/bh.4824