Syncopal high-degree AV block treated with catheter RF ablation without pacemaker implantation

ABSTRACT

A 23-year-old-female patient had undergone a very successful gastric banding surgery to treat obesity. Sixmonths later she began to present recurrent syncope due to very frequent, intermittent high-degree AV block referred to as pacemaker implantation. The electrophysiological study showed impaired AV nodalconduction but the His-Purkinje conduction was preserved. Partial catheter radiofrequency ablation of thecardiac autonomic nervous system guided by spectral endocardial mapping (cardioneuroablation) was performed. The electrophysiological parameters were normalized. Holter recordings were normal and the patient was asymptomatic with normal life without pacemaker implantation in a follow-up 21 months later.