How to perform cardioneuroablation for vasovagal syncope and functional bradycardia

As the most common cause of syncope, vasovagal syncope (VVS) is the result of cerebral hypoperfusion caused by sudden-onset bradycardia and mediated by parasympathetic overdrive. 1 Shen W.K. Sheldon R.S. Benditt D.G. et al. Writing Committee Members2017 ACC/AHA/HRS guideline for the evaluation and management of patients with syncope: A report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. Heart Rhythm. 2017; 14: e155-e217 Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar VVS is generally categorized into three types: cardioinhibitory, vasodepressive and mixed type. Patients with recurrent syncope are first treated with conservative measures such as fluid and salt intake, trigger avoidance, and physical counter-pressure maneuvers. Similar to VVS, parasympathetic overdrive, affecting the sinus node (SAN) and atrioventricular node (AVN), may cause symptomatic sinus nodal dysfunction (SND) and atrioventricular block (AVB). 2 Kusumoto F.M. Schoenfeld M.H. Barrett C. et al. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2019; 74: e51-e156 Crossref PubMed Scopus (204) Google Scholar ,3 Alboni P. Holz A. Brignole M. Vagally mediated atrioventricular block: pathophysiology and diagnosis. Heart. 2013; 99: 904‐908 Crossref PubMed Scopus (62) Google Scholar Functional SND and AVB, without intrinsic diseases in the SAN and AVN, are often reflex in origin. 2 Kusumoto F.M. Schoenfeld M.H. Barrett C. et al. 2018 ACC/AHA/HRS Guideline on the Evaluation and Management of Patients With Bradycardia and Cardiac Conduction Delay: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Rhythm Society. J Am Coll Cardiol. 2019; 74: e51-e156 Crossref PubMed Scopus (204) Google Scholar ,3 Alboni P. Holz A. Brignole M. Vagally mediated atrioventricular block: pathophysiology and diagnosis. Heart. 2013; 99: 904‐908 Crossref PubMed Scopus (62) Google Scholar Although bradycardias caused by parasympathetic overdrive are usually benign and occur in otherwise healthy persons, frequent episodes can be debilitating and impairs quality of life.