Selective vagal denervation guided by high frequency stimulation provided 9 months of symptom relief in a patient with refractory vasovagal syncope, followed by recurrence of vagal activity.
Case Report (n=1)
Does selective vagal denervation guided by high frequency stimulation prevent syncope in a patient with refractory neurally mediated syncope?
Selective vagal denervation guided by high frequency stimulation may provide temporary relief for refractory vasovagal syncope, but vagal reinnervation and symptom recurrence can occur within a year.
A 15-year-old female patient presented with frequent episodes of vasovagal syncope refractory to non-pharmacological and pharmacological measures. Two tilt-table tests performed before and after conventional therapy were positive and reproduced the patient's clinical symptoms. Selective vagal denervation, guided by HFS, was performed. Six radiofrequency pulses were applied on the left and right sides of the interatrial septum, abolishing vagal responses at these locations. Basal sinus node and Wenckebach cycle lengths changed significantly following ablation. A tilt test performed after denervation was negative and revealed autonomic tone modification. The patient reported significant improvement in quality of life and remained asymptomatic for 9 months after denervation. After this period, three episodes of NMS occurred during a 4-month interval and a tilt test performed 11 months after the procedure demonstrated vagal activity recovery.
Scanavacca et al. (Fri,) conducted a case report in Refractory neurally mediated syncope (n=1). Selective vagal denervation guided by high frequency stimulation was evaluated on Clinical symptoms and vagal responses. Selective vagal denervation guided by high frequency stimulation provided 9 months of symptom relief in a patient with refractory vasovagal syncope, followed by recurrence of vagal activity.