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Optimizing cardioneuroablation candidate selection: a case report using tilt-table testing with Russo's Fast Italian

Dorina Stangl¹, Veronica Buia¹, Janusch Walaschek¹

¹Medizinische Klinik I, Klinikum Fürth, Academic Teaching Hospital of the Friedrich-Alexander-University Erlangen-Nürnberg, Jakob-Henle Str. 1, Fürth 90766, Germany.

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Summary

Cardioneuroablation (CNA) offers a promising alternative to pacemakers for vasovagal syncope (VVS). A novel Fast Italian Protocol (FIP) effectively identified a patient for CNA, resulting in zero syncope recurrences at 12 months.

Keywords:

Cardioneuroablation Case report Fast Italian Protocol (FIP)Head-up tilt-table test (HUTT)

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Area of Science:

Cardiology
Electrophysiology

Background:

Vasovagal syncope (VVS) management often involves conventional pacing, but cardioneuroablation (CNA) presents a novel therapeutic option.
Accurate patient selection and diagnosis are critical for successful CNA outcomes.
A standardized protocol for CNA patient selection is currently lacking.

Observation:

A 44-year-old male with recurrent syncope underwent head-up tilt-table testing using the Fast Italian Protocol (FIP).
The FIP identified a cardioinhibitory vasovagal response, typically treated with pacemakers.
The patient elected for CNA, involving radiofrequency ablation of ganglionated plexi.

Findings:

Successful radiofrequency ablation of ganglionated plexi was performed.
The patient experienced no recurrence of syncopal episodes at 12-month follow-up.
The FIP demonstrated efficacy in diagnosing cardioinhibitory vagal responses.

Implications:

The FIP shows potential as a diagnostic tool for selecting patients for CNA.
CNA offers a viable alternative to pacing for VVS patients.
Further research is warranted to standardize the FIP for CNA patient selection and non-invasive follow-up.