Cardioneuroablation—Therapeutic Option for Selected Patients with Vasovagal Syncope

Objectives: A 15-year-old boy was referred to our clinic for implantation of a permanent pacemaker because of >10 syncopal episodes with injury while seeing or just talking about blood or other “unpleasant” topics. During the last syncopal episode while taking blood sample in the clinic after syncope at school, there was an asystole lasting 13 seconds due to transient complete AV block documented on Holter. There wasn't another episode of AV prolongation/block on Holter recording, demonstrating that there is no structural disease of the conduction system. The functional AV block is caused by parasympathetic overactivity. Elimination of this parasympathetic activity by intracardiac catheter ablation of parasympathetic ganglionated plexi around the heart, cardioneuroablation may be a causal therapy of this disease.

Methods: The patient was scheduled for cardioneuroablation. Procedure was done in general anesthesia and mechanical ventilation. One diagnostic catheter was placed into v. jugularis at the level of the neck to stimulate n. vagus using a special stimulator. This stimulation caused before ablation an asystole, and we used it to check the effect of ablation during the procedure. Anatomical shells of the right atrium, the SVC, IVC, CS, and LA with PVs were created using 3D mapping system. N. phrenicus course and sinus node location was noted. The ablation with irrigated catheter was performed in RA and LA. After last ablation, there was no asystole inducible by vagal stimulation.

Conclusion: During the FUP of 7 months, there is no syncope, the patient is doing well, completely asymptomatic. The cardioneuroablation is in selected patients with vasovagal syncope effective therapeutic option and should be discussed prior to pacemaker implantation.

Publication History

Article published online:
21 February 2021