Cardioneuroablation: Catheter Vagal Denervation as a New Therapy for Cardioinhibitory Syncope

• Published in: Journal of cardiac arrhythmias 2020-01, Vol.32 (3)
• Main Authors: José Carlos Pachon Mateos, Enrique I Pachón Mateos, Christian Higuti, Tomas Guilhermo Santillana Peña, Tasso Julio Lobo, Carlos Thiene Cunha Pachón, Juán Carlos Pachón Mateos, Juán Carlos Zerpa Acosta, Felipe Ortencio, Ricardo Amarante
• Format: Article
• Language: English
• ISSN: 2674-7472

The vasovagal syncope is the most frequent cause of transient loss of consciousness, especially in young people without significant heart disease. The malignant cardioinhibitory form is caused by abrupt and intense vagal reflex with or without defined triggers. Refractory cases to preventive measures and pharmacological handling has been treated with definitive pacemaker implantation. Besides showing questionable results, pacemaker implantation is highly rejected by young patients. In the late 1990s, we proposed specific vagal denervation by catheter ablation and spectral mapping, for paroxysmal AF, functional bradyarrhythmias and severe cases of malignant cardioinhibitory syncope giving rise to cardioneuroablation. Recently, many authors worldwide have been reproducing the cardioneuroablation results where elimination or significant reduction of the vagal response were observed, which abolished symptoms in more than 75% of patients followed up to 14 years, without complications. Therefore, cardioneuroablation has shown to be a real therapeutic option in malignant syncope cardioinhibitory and in any exclusive vagal mediated bradyarrhythmia without the need for pacemaker implantation.