Cardioneuroablation for Refractory Vasovagal Storm Secondary to a Right Hilar Tumor.

BACKGROUND

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

CASE SUMMARY

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.

DISCUSSION

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.

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