Cardioneuroablation for Refractory Vasovagal Storm Secondary to a Right Hilar Tumor

Cardiac syncope due to sinus arrest may result from either a vasovagal cardioinhibitory mechanism or an intrinsic sinus node dysfunction.

A 67-year-old woman with a recently diagnosed right hilar mass presented with new-onset episodes of syncope associated with sinus arrest. Resting electrocardiogram was normal, and no electrolyte abnormalities were identified. Detailed analysis of telemetry recordings revealed a typical vasovagal cardioinhibitory response. The patient underwent a cardioneuroablation procedure. Since the procedure, there has been no recurrence of syncope or evidence of sinus pause.

A vasovagal cardioinhibitory response may be triggered by mechanical compression of the vagus nerve or ganglionated plexi. Cardioneuroablation represents a valuable alternative to permanent pacemaker implantation and should be considered in appropriately selected patients.

This case highlights the diagnostic telemetry features of vasovagal cardioinhibitory response in an unusual cause of vasovagal syncope, guiding appropriate management with cardioneuroablation.