Cardioneuroablation for swallowing-induced syncope: To pace or to ablate, that is the question

Key Teaching Points•Cardioneuroablation can be considered as an alternative to pacing in selected patients with swallow syncope that are refractory to conservative management.•The sites and extent of ablation depend on the type of cardioinhibitory response (asystole vs atrioventricular block), although a complete vagal denervation involving both atria probably offers the best chances of clinical success.•Zero-fluoroscopy is a feasible approach for cardioneuroablation that minimizes the effects of radiation exposure for patients and health care staff. •Cardioneuroablation can be considered as an alternative to pacing in selected patients with swallow syncope that are refractory to conservative management.•The sites and extent of ablation depend on the type of cardioinhibitory response (asystole vs atrioventricular block), although a complete vagal denervation involving both atria probably offers the best chances of clinical success.•Zero-fluoroscopy is a feasible approach for cardioneuroablation that minimizes the effects of radiation exposure for patients and health care staff.