Long-term Success of Cardioneuroablation in a Patient with Tachycardia-bradycardia Syndrome and Syncope

Abstract

A case of successful treatment for syncopal episodes caused by intermittent atrioventricular block in a patient with paroxysmal atrial fibrillation/atrial flutter using cardioneuroablation is presented.

Keywords: Atrial fibrillation; atrioventricular block; cardioneuroablation; ganglionated plexus syncope.

Figure 1:

ECG tracings registered during Holter monitoring before ablation. A: A pause of 12.9 seconds in duration caused by paroxysmal AV block during AF. B: Fast ventricular response during AF, confirming the absence of structural conduction impairment. C: AV block developing during night hours simultaneously with SR deceleration most likely resulting from both sinus and AV node suppression by the increased vagal tone.

Figure 2:

A: Three-dimensional reconstruction of LA and left ventricular computed tomography angiography in the anteroposterior view; red dots show the regions of additional RF lesions aiming at the right superior and left superior GPs. B: Chest X-ray in the anteroposterior view, demonstrating the position of the mapping catheter during RF ablation in the region of the left superoposterior GP. A Lasso catheter in the left superior PV ostium and a decapolar catheter in the coronary sinus (CS) are also shown. C: Chest X-ray in the right oblique view, demonstrating the position of the mapping catheter during RF ablation in the region of the right anterosuperior GP. A Lasso catheter in the right superior PV ostium and a decapolar catheter in the CS are also shown.