Selective Atrial Vagal Denervation Guided by Evoked Vagal Reflex to Treat Refractory Vasovagal Syncope

A 57‐year‐old woman with refractory vasovagal syncope and a sinus pause of 6.8 seconds during tilt‐table test accepted the suggestion of atrial vagal denervation. Radiofrequency pulses were delivered on positive vagal reflex sites according to the standard of heart rate (HR) drop ≥20% after high frequency stimulation (HFS). The endpoint of inexistence of HR decrease at repeating HFS was achieved in 18 sites. No syncope attacked during 12 months and three tilt‐table tests performed at 1, 6, and 12 months were negative. Extensive ablation on atrial endocardium for vagal denervation is suggested to be efficient in cardioinhibition type of VVS. (PACE 2012;1–5)