Syncopal high-degree AV block treated with catheter RF ablation without pacemaker implantation

Area of Science:

• Cardiology
• Autonomic Nervous System Research
• Medical Device Technology

Background:

• Obesity is a significant health concern, often managed with surgical interventions like gastric banding.
• Gastric banding surgery can have rare but serious complications, including cardiac arrhythmias.
• Understanding the link between autonomic dysfunction and cardiac events post-bariatric surgery is crucial.

Observation:

• A 23-year-old female developed recurrent syncope six months after successful gastric banding.
• Investigations revealed intermittent high-degree atrioventricular (AV) block, necessitating consideration for pacemaker implantation.
• Electrophysiological studies indicated impaired AV nodal conduction with preserved His-Purkinje system function.

Findings:

• A novel procedure, partial catheter radiofrequency ablation of the cardiac autonomic nervous system (cardioneuroablation), was performed.
• This intervention utilized spectral endocardial mapping for precise guidance.
• Post-procedure, electrophysiological parameters normalized, and Holter monitoring showed no further abnormalities.

Implications:

• Cardioneuroablation offers a potential non-pacemaker solution for specific types of AV block linked to autonomic dysfunction.
• This case highlights the importance of considering autonomic nervous system involvement in post-surgical cardiac complications.
• Successful long-term management without a pacemaker was achieved, improving patient quality of life.