Transient Reflex Tachycardia After Cardioneuroablation for Vasovagal Syncope in an Endurance Athlete.

BACKGROUND

Cardioneuroablation (CNA) is an emerging therapy for cardioinhibitory vasovagal syncope, but its autonomic effects in athletes remain poorly defined.

CASE SUMMARY: A 44-year-old endurance athlete presented with recurrent syncope and a documented 20-second sinus pause. Structural heart disease was excluded, and tilt testing was nondiagnostic. To avoid pacemaker implantation and preserve athletic capacity, targeted CNA of the paraseptal ganglionated plexi was performed. This resulted in increased resting heart rate and a blunted atropine response. Shortly after, she developed symptomatic orthostatic tachycardia with hypotension. Symptoms resolved with short-term, low-dose beta-blocker therapy, which was subsequently discontinued. At a 12-month follow-up, she remained asymptomatic and returned to unrestricted endurance training.

DISCUSSION: Although CNA is increasingly used to treat vasovagal syncope, postprocedural autonomic imbalance, including reflex tachycardia, is under-recognized, particularly in athletes.

TAKE-HOME MESSAGES: CNA may induce transient orthostatic tachycardia in athletes. Anticipatory counseling and structured follow-up are essential.