Selective cardioneuroablation of the posteromedial left ganglionated plexus for drug-resistant swallow syncope with functional atrioventricular block

Key Teaching Points•Although pacemaker implantation is a well-established therapy for swallow syncope, it is generally deemed inappropriate for young patients (aged <40 years). Cardioneuroablation targeting ganglionated plexuses (GPs) located on the epicardial side of the right and left atria is an attractive therapeutic option for swallow syncope, especially in young patients.•The posteromedial left GP is considered the final direct pathway of the parasympathetic nerve input to the atrioventricular (AV) node. Therefore, ablation of the posteromedial left GP is critically important to denervate the AV node in the treatment of functional AV block.•When the sinus rate is maintained (>60 beats/min) at the time of functional AV block, minimal cardioneuroablation selectively targeting the posteromedial left GP may be sufficient to eliminate syncopal episodes. •Although pacemaker implantation is a well-established therapy for swallow syncope, it is generally deemed inappropriate for young patients (aged <40 years). Cardioneuroablation targeting ganglionated plexuses (GPs) located on the epicardial side of the right and left atria is an attractive therapeutic option for swallow syncope, especially in young patients.•The posteromedial left GP is considered the final direct pathway of the parasympathetic nerve input to the atrioventricular (AV) node. Therefore, ablation of the posteromedial left GP is critically important to denervate the AV node in the treatment of functional AV block.•When the sinus rate is maintained (>60 beats/min) at the time of functional AV block, minimal cardioneuroablation selectively targeting the posteromedial left GP may be sufficient to eliminate syncopal episodes.