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

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.