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June 13, 2025Arrhythmia & Electrophysiology ReviewOpen Access

Cardioneuroablation for reflex syncope linked to intractable IST requiring sinus node modification and pacemaker.

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Why the study?

Because cardioneuroablation involves parasympathetic denervation, inappropriate sinus tachycardia may be an underappreciated potential adverse effect.

Does cardioneuroablation cause inappropriate sinus tachycardia in patients with reflex syncope?

Design

Case report and literature review

Key result

Cardioneuroablation for reflex syncope in an 18-year-old female resulted in intractable inappropriate sinus tachycardia, ultimately requiring sinus node modification and pacemaker implantation.

Authors

PKPiotr KułakowskiRPRoman Piotrowski

Discussion

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Overview

Warns of intractable IST after cardioneuroablation for reflex syncope; leaves open incidence and risk mitigation.

Key Points

  • To evaluate inappropriate sinus tachycardia as an underrecognized adverse consequence of cardioneuroablation and explore diagnostic and therapeutic challenges associated with this complication.
  • Documented a clinical case of mixed vasovagal syncope and symptomatic sinus bradycardia treated with cardioneuroablation that subsequently progressed to inappropriate sinus tachycardia.
  • Reviewed available literature to assess the incidence, clinical definitions, and management strategies for inappropriate sinus tachycardia following cardiac parasympathetic denervation.
  • Parasympathetic denervation during cardioneuroablation successfully relieved bradycardia but induced persistent inappropriate sinus tachycardia, ultimately necessitating pacemaker implantation.
  • Literature review revealed substantial ambiguity in the definition, reporting frequency, and therapeutic protocols for managing tachycardia after cardioneuroablation.

Study Design

Type

Case Report (n=1)

Multicenter

No

Structured PICO

Does cardioneuroablation cause inappropriate sinus tachycardia in patients with reflex syncope?

P
Population
1 patient with mixed vasovagal syncope and symptomatic sinus bradycardia
I
Intervention
Cardioneuroablation (CNA)
O
Outcome
Development of inappropriate sinus tachycardia (IST)safety

Cardioneuroablation for reflex syncope can lead to inappropriate sinus tachycardia as an adverse effect, potentially requiring pacemaker implantation.

Limitations

  • Post-CNA inappropriate sinus tachycardia is likely under-reported in the literature.
  • Terminology and definitions of post-CNA inappropriate sinus tachycardia vary broadly across studies.
  • There is no optimal follow-up scheme recommended for detecting this complication.
  • The long-term adverse effects and prognosis of persistent post-CNA inappropriate sinus tachycardia remain unknown.

Cite This Study

Kułakowski et al. (2025) conducted a case report in Reflex syncope and functional bradycardia (n=1). Cardioneuroablation (CNA) was evaluated. Cardioneuroablation for reflex syncope in an 18-year-old female resulted in intractable inappropriate sinus tachycardia, ultimately requiring sinus node modification and pacemaker implantation.

synapsesocial.com/papers/6a0c6bff93c2b42b5c8867dchttps://doi.org/10.15420/aer.2025.01
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