Limitations
A limitation of this study is the relatively small number of patients in the NoECVS group (2 cases). This can be reasonably explained by the stringent patient selection criteria applied to both groups, and it underscores the ethical concerns regarding uncontrolled CNA without ECVS confirmation. However, the statistical analysis demonstrates that the two groups are sufficiently equivalent and suitable for comparison. It is crucial to recognize that patient selection was rigorously conducted, and the number of cases with predominantly cardioinhibitory neurocardiogenic syncope is inherently limited, as only severe cases with complete resistance to conservative treatment were included. Additionally, only cases performed by three highly trained operators were included to ensure maximum equivalence and technical reproducibility of the procedures.