Carotid sinus hypersensitivity syncope: is there a possible alternative approach to pacemaker implantation in young patients?

Changes in autonomic response during cardioneuroablation in an elderly patient with carotid sinus syndrome

“…To the best of our knowledge, this is the first case reporting the success use of CNA for the treatment of CSS in an elderly and frail patient. While there are several studies describing its efficacy in the reduction of syncope burden in VVS, there is little evidence in CSS with only two cases published in the literature in young patients 3,4 . In this regard, although the physiopathology of neuromediated syncope is complex, in CCS the abnormal efferent response is due to a disturbance of the carotid sinus baroreceptor J o u r n a l P r e -p r o o f 6 function.…”

“…Although several studies have described its efficacy in reducing syncope burden in VVS, there is little evidence for its use in CSS, with only 2 cases of young patients reported in the literature. 3 , 4 In this regard, although the physiopathology of neuromediated syncope is complex, in CSS the abnormal efferent response is due to a disturbance of carotid sinus baroreceptor function. Furthermore, it is important to distinguish between the dominant vasodepressor, the dominant cardioinhibitory, and the mixed forms because CNA potentially will be more effective in the latter 2 forms.…”

“…Its main objective is the elimination of the efferent pathway of the parasympathetic autonomic nervous system by endocardial catheter radiofrequency GP ablation, abolishing the vagal cardioinhibitory response. However, this therapeutic approach has been used mainly for VVS, particularly in young patients and only anecdotal cases have been reported in CSS 3,4 . Furthermore, although the main case of syncope in the elderly is a reflex mechanism, there is little evidence of its use in this population and the best approach (uni or biatrial).…”

“…However, this therapeutic approach has been used mainly for VVS, particularly in young patients, and only anecdotal cases have been reported for CSS. 3 , 4 Furthermore, although the main cause of syncope in the elderly is a reflex mechanism, there is little evidence of CNA use in this population and the best approach (uniatrial or biatrial) for its use. In this case report, we present the successful use of CNA for treatment of CSS in an elderly woman.…”

Disautonomia: Uma Condição Esquecida – Parte 1

“…104 A cardioneuroablação já foi utilizada para tratar paciente com hipersensibilidade do seio carotídeo, podendo ser uma alternativa ao implante de marca-passo, especialmente em indivíduos jovens que são mais vulneráveis às complicações a longo prazo. 105,106 Em resumo, a ablação de plexos ganglionares pode promover significante redução da atividade vagal, nos nós sinusal e atrioventricular, sendo efetiva em reduzir sintomas em pacientes com bradicardia acentuada neuromediada. Devido às diferentes técnicas empregadas, estudos randomizados multicêntricos seriam necessários para definir a eficácia, a melhor técnica, a segurança e a reprodutibilidade do método.…”