Key result
Cardioneuroablation eliminates vagal responses and prevents recurrent syncope in vagally mediated coronary spasm.
Why the study?
A parasympathetic-dominant phenotype of coronary artery spasm causing ischemia, arrhythmias, and syncope without obstructive coronary disease is increasingly recognized, but targeted treatment options are limited.
Does cardioneuroablation prevent syncope and atrioventricular block in a patient with vagally mediated coronary artery spasm?
Case Report (n=1)
Does cardioneuroablation prevent syncope and atrioventricular block in a patient with vagally mediated coronary artery spasm?
Cardioneuroablation may interrupt the autonomic cascade in carefully selected patients with parasympathetic-dominant coronary artery spasm and reflex syncope.
May support CAS evaluation in unexplained nocturnal syncope with AV block; leaves open prospective validation of phenotype-specific management.
BACKGROUND: Coronary artery spasm (CAS) may cause ischemia, malignant arrhythmias, and syncope without obstructive coronary disease; a parasympathetic-dominant phenotype is increasingly recognized. CASE SUMMARY: A 64-year-old man with >7 years of recurrent syncope had Holter documentation of transient inferior ST-segment elevation during sleep followed by high-grade atrioventricular block. Coronary angiography showed no significant stenosis, and head-up tilt testing was positive (mixed type). Cardioneuroablation (CNA) targeting atrial ganglionated plexi abolished vagal responses and improved electrophysiologic indices. Postprocedural Holter showed no recurrent ST-segment elevation or atrioventricular block, and he remained symptom-free at 1-month follow-up. DISCUSSION: The close sequence of ST-segment elevation and functional atrioventricular block supports a unified vagally mediated mechanism linking CAS and reflex syncope; CNA may be a mechanistically targeted option in selected refractory cases. TAKE-HOME MESSAGES: Nocturnal ST-segment elevation with bradyarrhythmia suggests parasympathetic-dominant CAS. CNA can interrupt this autonomic cascade in carefully selected patients.
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Zhao et al. (2026) conducted a case report in Vagally Mediated Coronary Artery Spasm With High-Grade Atrioventricular Block and Vasovagal Syncope (n=1). Cardioneuroablation (CNA) targeting atrial ganglionated plexi was evaluated on Recurrent ST-segment elevation, atrioventricular block, and symptoms. Cardioneuroablation abolished vagal responses and prevented recurrent ST-segment elevation, AV block, and syncope at 1-month follow-up in a patient with vagally mediated coronary artery spasm.
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