Carotid sinus syndrome treated by cardioneuroablation: Is sinus node denervation enough? Insights from a syncope recurrence report

Figures

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  Figure 1. Six months after the first cardioneuroablation. A: Spontaneous atrioventricular block (AVB) during syncope. B: High-degree AVB during carotid sinus massage. C: Carotid sinus massage after atropine without AVB.

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  Figure 2. Before and after second cardioneuroablation (CNA): extracardiac vagal stimulation (ECVS) evaluation, atrial fibrillation (AF) nest, anatomical- and fractionation map–guided CNA. A: Initial ECVS response showing transient atrioventricular block (AVB) and absence of sinus rate changes. B: Electroanatomic mapping right anterior oblique (RAO) view of fractionation map location G3 (area related to posterior medial ganglionated plexus) and radiofrequency (RF) lesion set. Red circle = filtered ablation catheter electrogram (300–500 Hz) for atrial fibrillation nest mapping at the G3 location; red dots = RF lesion set. C: ECVS response after biatrial second CNA showing absence of vagally induced asystole or AVB. D: Left vagus ECVS catheter position.

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  Figure 3. The 24-hour ventricular heart rate pattern and heart rate variability (HRV) in time domain. A: Before cardioneuroablation. B: Six months post second cardioneuroablation. C: Twenty months post second cardioneuroablation.