ArticleJACC. Case reports2026
Cardioneuroablation for Vagally Mediated Coronary Artery Spasm With High-Grade Atrioventricular Block and Vasovagal Syncope.
Article in JACC. Case reports, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundCoronary artery spasm (CAS) may cause ischemia, malignant arrhythmias, and syncope without obstructive coronary disease; a parasympathetic-dominant phenotype is increasingly recognized. CASE SUMMARY: A 64-year-old man with >7 years of recurrent syncope had Holter documentation of transient inferior ST-segment elevation during sleep followed by high-grade atrioventricular block. Coronary angiography showed no significant stenosis, and head-up tilt testing was positive (mixed type). Cardioneuroablation (CNA) targeting atrial ganglionated plexi abolished vagal responses and improved electrophysiologic indices. Postprocedural Holter showed no recurrent ST-segment elevation or atrioventricular block, and he remained symptom-free at 1-month follow-up. DISCUSSION: The close sequence of ST-segment elevation and functional atrioventricular block supports a unified vagally mediated mechanism linking CAS and reflex syncope; CNA may be a mechanistically targeted option in selected refractory cases. TAKE-HOME MESSAGES: Nocturnal ST-segment elevation with bradyarrhythmia suggests parasympathetic-dominant CAS. CNA can interrupt this autonomic cascade in carefully selected patients.
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