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. 2025 Aug 28.
doi: 10.1007/s00399-025-01103-8. Online ahead of print.

Cardioinhibitory reflex syncope : Cardioneuroablation as a therapeutic alternative

Amelie Beblo  1 , Robert Hättasch  2 , Nikolaos Dagres  2 , Felix Hohendanner  2 , Gerhard Hindricks  2 , Sergio Richter  3 , Verena Tscholl  2
Affiliations

Cardioinhibitory reflex syncope : Cardioneuroablation as a therapeutic alternative

Amelie Beblo et al. Herzschrittmacherther Elektrophysiol. .

Abstract
in English, German

The case of a 36-year-old female patient with recurrent reflex syncope characterized by predominant cardioinhibition and episodes of asystole lasting up to 9 s, as documented by an implantable loop recorder, is reported. Given her young age and symptomatic burden, cardioneuroablation (CNA) was performed without complications as an alternative to pacemaker implantation, in accordance with European Heart Rhythm Association (EHRA) recommendations. In this case, CNA has shown to be an effective and safe treatment option for managing recurrent cardioinhibitory reflex syncope. CNA should particularly be considered and offered in specialised centres for symptomatic patients under 40 years of age, in which treatment options beyond conservative measures remain limited.

Wir berichten über eine 36-jährige Patientin mit multiplen Reflexsynkopen vom kardioinhibitorischen Typ und mit über einen implantierbaren Loop-Rekorder dokumentierten Asystolieepisoden bis zu 9 s. Angesichts ihres jungen Alters und der Symptomlast wurde eine Kardioneuroablation (CNA) als Alternative zur Schrittmacherimplantation gemäß den Empfehlungen der European Heart Rhythm Association (EHRA) komplikationslos durchgeführt. Die CNA stellte sich hier als eine effektive und sichere therapeutische Option zur Behandlung rezidivierender Reflexsynkopen vom kardioinhibitorischen Typ dar. Insbesondere für symptomatische Patienten unter 40 Jahren, bei denen die Behandlungsmöglichkeiten über konservative Maßnahmen hinaus begrenzt sind, sollte die CNA in Betracht gezogen und in spezialisierten Zentren angeboten werden.

Keywords: Cardioinhibition; Electrophysiological study; Event recorder; Parasympathetic ganglia; Vagal denervation.

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Conflict of interest statement

Declarations. Conflict of interest: A. Beblo, R. Hättasch, N. Dagres, F. Hohendanner, G. Hindricks, S. Richter, and V. Tscholl declare that they have no competing interests. For this article no studies with human participants or animals were performed by any of the authors. All studies mentioned were in accordance with the ethical standards indicated in each case. For images or other information within the manuscript which identify patients, consent was obtained from them and/or their legal guardians.

References

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