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July 23, 2026European Heart Journal - Case ReportsOpen Access

Cardioneuroablation resolves symptoms in a patient with severe nocturnal vagal hyperreactivity by restoring autonomic balance.

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Why the study?

Does cardioneuroablation improve symptoms and reduce pacemaker rate-drop responses in a patient with vagal hyperreactivity unmasked after pacemaker implantation?

Population

1 43-year-old man with recurrent syncope due to abrupt, prolonged sinus arrest without escape rhythm, who…

Design

Case_report

Key result

Cardioneuroablation successfully restored autonomic balance, reduced pacemaker rate-drop responses, and resolved symptoms in a patient with severe nocturnal vagal hyperreactivity.

Authors

MMMuhemin MohammedGSGonca SunaAPAju P. Pazhenkottil

Discussion

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Overview

CNA may be feasible post-pacemaker in vagal asystole; leaves open patient selection and long-term outcomes.

Key Points

  • The aim is to showcase the rare occurrence of vagal hyperreactivity leading to asystole after pacemaker implantation and the effectiveness of cardioneuroablation.
  • Case report of a 43-year-old man with recurrent syncope and prolonged sinus arrest after pacemaker implantation.
  • Implantation of a dual-chamber pacemaker and monitoring device diagnostics revealed significant nocturnal rate-drop responses.
  • Cardioneuroablation was performed due to severe symptoms from vagally mediated episodes.
  • The patient experienced substantial suppression of nocturnal vagal episodes post-cardioneuroablation.
  • Symptomatic improvement was marked, leading to the resolution of severe daytime somnolence.
  • Device data showed a significant reduction in rate-drop responses after CNA intervention.

Study Design

Type

Case Report (n=1)

Structured PICO

Does cardioneuroablation improve symptoms and reduce pacemaker rate-drop responses in a patient with vagal hyperreactivity unmasked after pacemaker implantation?

P
Population
A 43-year-old man with recurrent syncope due to prolonged sinus arrest who developed severe nocturnal vagal hyperreactivity after pacemaker implantation.
I
Intervention
Cardioneuroablation (CNA)
O
Outcome
Suppression of nocturnal vagal episodes and symptomatic improvement

Cardioneuroablation can successfully restore autonomic balance and resolve debilitating symptoms in patients with severe vagal hyperreactivity unmasked by pacemaker implantation.

Cite This Study

Mohammed et al. (2026) conducted a case report in Recurrent syncope due to prolonged sinus arrest and vagal hyperreactivity (n=1). Cardioneuroablation was evaluated on Suppression of nocturnal vagal episodes and symptomatic improvement. Cardioneuroablation successfully restored autonomic balance, reduced pacemaker rate-drop responses, and resolved symptoms in a patient with severe nocturnal vagal hyperreactivity.

synapsesocial.com/papers/6a61b004faa9903c5116ab40https://doi.org/10.1093/ehjcr/ytag526
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