Transient Reflex Tachycardia After Cardioneuroablation for Vasovagal Syncope in an Endurance Athlete

Figures

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  Figure 1. Electrocardiogram on Presentation to the Emergency Department Electrocardiogram showing normal sinus rhythm and T-wave inversions in V1 to V3.

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  Figure 2. External Loop Recorder Demonstrating Prolonged Sinus Pause External loop recording during the syncopal event, showing progressive slowing of the sinus rate (top) followed by a prolonged sinus pause of 20 seconds (bottom).

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  Figure 3. Electroanatomical Mapping and Ablation Targets (A) Right lateral view demonstrating ablation lesions (red) at the RAGP, PMLGP, and CS. (B) Left anterior oblique view showing ablation sites (red) with corresponding fractionated electrograms (blue arrows) at targeted ganglionated plexus regions. (C) Representative fractionated electrograms recorded from the right and left atria, used to guide ablation. CS = coronary sinus; PMLGP = posteromedial left atrial ganglionated plexus; RAGP = right anterior ganglionated plexus.

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  Figure 4. Implantable Loop Recorder Heart Rate Trend During Follow-Up Implantable loop recorder tracing demonstrates an initial increase in resting heart rate after cardioneuroablation, followed by gradual normalization. At 12 months, basal heart rate stabilized at ∼70 beats/min, approaching the preablation baseline (∼60 beats/min), consistent with improved autonomic regulation. AT/AF = atrial tachycardia/atrial fibrillation.

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  Visual Summary. Cardioneuroablation in an Endurance Athlete CAN = cardioneuroablation; CS = coronary sinus; ELR = external loop recorder; PMLGP = posteromedial left atrial ganglionated plexus; RAGP = right anterior ganglionated plexus.