Selective Modulation of the Cardiac Autonomic Nervous System: A New Therapeutic Strategy for Cardioinhibitory Vasovagal Syncope

Vasovagal syncope (VVS) is the most common type of syncope. The overall prognosis of VVS is usually benign, although the quality of life can be affected when syncope is recurrent and refractory to conventional therapy. Multiple treatment options exist for patients with recurrent VVS, although the effect is modest. In this focused review, we briefly discussed the plausible pathophysiological mechanisms of VVS. We used three case examples to update the current state of cardioneuroablation (CNA) in patients with recurrent cardioinhibitory response as a potential therapeutic option. This article includes review of studies and reports on CNA summarizing the principles of this therapeutic approach; various ways of mapping to localize the parasympathetic ganglionic plexi for ablation; description of technique of extra-cardiac vagal stimulation to confirm parasympathetic denervation of the heart as well as the end points and outcomes of the reported studies. Moreover, we reviewed the pros, cons, gaps, and future directions of this potential therapeutic option in treating patients with VVS.