Key result
Combined WACA and CNA linked to lasting relief of vagally mediated swallowing syncope in AF.
Why the study?
Swallowing syncope is a neurally mediated reflex syncope often due to excessive vagal activation, and cardioneuroablation is an emerging alternative to pacemaker therapy in selected cases.
Case Report (n=1)
Combined WACA and CNA provided durable relief of vagally mediated swallowing syncope in a patient with AF, suggesting a viable pacemaker-sparing therapeutic strategy.
Answers are grounded in this paper and cite their sources.
May support combined WACA and CNA for vagally mediated swallowing syncope in AF; hypothesis-generating and should not yet change practice.
BACKGROUND: Swallowing syncope is a neurally mediated reflex syncope triggered by deglutition, often due to excessive vagal activation. Cardioneuroablation (CNA) is an emerging alternative to pacemaker therapy in selected cases. CASE SUMMARY: A 75-year-old man with atrial fibrillation (AF) presented with recurrent swallowing-induced syncope. During esophagogastroduodenoscopy, he developed reproducible bradycardia, confirming a vagally mediated cardioinhibitory response. He underwent combined wide area circumferential ablation (WACA) and targeted CNA with radiofrequency ablation. After ablation, his symptoms resolved, with maintenance of sinus rhythm at 1 year. Heart rate variability analysis showed a marked reduction in SDNN (standard deviation of all normal-to-normal intervals) from 138.7 to 59.4 ms, indicating a parasympathetic withdrawal pattern. DISCUSSION: This case highlights the successful management of swallowing syncope with concomitant AF using combined WACA and CNA with radiofrequency ablation-a novel, pacemaker-sparing therapeutic strategy. TAKE-HOME MESSAGE: Combined WACA and CNA provide durable relief of vagally mediated swallowing syncope in patients with AF.
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Chiang et al. (2026) conducted a case report in Swallowing syncope with atrial fibrillation (n=1). Combined wide area circumferential ablation (WACA) and targeted cardioneuroablation (CNA) with radiofrequency ablation was evaluated on Symptom resolution and maintenance of sinus rhythm. Combined wide area circumferential ablation and cardioneuroablation resolved swallowing syncope and maintained sinus rhythm at 1 year, with SDNN reduced from 138.7 to 59.4 ms.
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