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Vasovagal syncope with isolated atrioventricular block following cardioneuroablation demonstrating distinct innervation of the sinus and atrioventricular nodes

ABSTRACT:

SUBMITTER: Maher T

PROVIDER: S-EPMC9811026 | biostudies-literature | 2022 Aug

REPOSITORIES: biostudies-literature

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A case report of one vasovagal syncope patient with third-degree atrioventricular block caused by SCN5A gene mutation and literature review.

Project description:BackgroundVasovagal syncope (VVS) is common in children and significantly affects their quality of life. To our knowledge, this the first case report of SCN5A gene mutation associated with VVS and third-degree atrioventricular block (atrioventricular block, AVB), which could help pediatricians aware that VVS is not always a benign condition and help to identify VVS children at the risk of sudden death.Case presentationA twelve-year-old male child was admitted to Beijing Children's Hospital of Capital Medical University for chest tightness for 9 days and syncope in July 2018. The child was diagnosed as VVS with third-degree AVB after complete investagations. A heterozygous mutation in the exon coding region of the SCN5A gene, C. 5851G > T (coding region 5551 nucleotide changed from G to T), was detected in the peripheral blood of the child. Electrophysiological examination and modified vagal ganglion radiofrequency ablation were performed in the child. The ECG playback was normal on the second day after operation. Holter showed no abnormality and no chest tightness or syncope occurred after 3 months and 1 year follow-up.ConclusionsOur case report firstly reported that SCN5A mutation contributed to the pathogenesis of VVS with third-degree AVB. Vagal ganglion modified ablation have obtained good therapeutic effect. Gene analysis was of great value to the accurate diagnosis and treatment of VVS children.

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Step-by-Step Cardioneuroablation Approach in Two Patients with Functional Atrioventricular Block

Project description:Parasympathetic overactivity may cause functional atrioventricular block episodes and necessitate pacemaker implantation in symptomatic cases and those refractory to conventional therapies. In these patients, if it can be clearly demonstrated that there is no structural damage in the conduction system, elimination of the vagal activity based on radiofrequency catheter ablation of main ganglionated plexi around the heart, which is called as cardioneuroablation, might be a rational approach. In this review article, we try to discuss patient selection and procedural steps suitable for cardioneuroablation based on two patients with functional atrioventricular block.

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Case Report: Painful left bundle branch block syndrome complicated with vasovagal syncope.

Project description:BackgroundPainful left bundle branch block (LBBB) syndrome is an uncommon disease that is defined as intermittent episodes of angina associated with simultaneous LBBB changes on an electrocardiogram (ECG) with the absence of flow-limiting coronary artery disease or ischemia on functional testing. Vasovagal syncope (VVS) is the most common cause of syncope and can be provoked by sublingual nitroglycerin (NTG). Herein, we report a case of painful LBBB syndrome complicated with VVS, which was misdiagnosed as acute coronary syndrome and cardiogenic shock.Case summaryA 62-year-old woman presented with intermittent exertional chest pain for 3 years and deteriorated for 2 weeks. An ECG, transthoracic echocardiography, and laboratory test results were all normal. Exercise treadmill testing induced chest pain, accompanied by new-onset LBBB. She fainted after finishing the test and receiving sublingual NTG, with a rapid decline in heart rate and blood pressure, which was relieved by 0.5 mg of atropine administered intravenously. Coronary angiography showed no evidence of obstructive lesions. Isoprenaline stress echocardiography induced chest pain and rate-dependent LBBB and showed interventricular/intraventricular desynchrony simultaneously. A head-up tilt test verified mixed VVS in the provocative phase. A diagnosis of painful LBBB syndrome complicated with VVS induced by sublingual NTG was made. The patient received an extended-release metoprolol succinate tablet and had no symptoms at a 1-year follow-up.ConclusionPainful LBBB syndrome is an uncommon cause of chest pain and is often overlooked by physicians. Misdiagnosis and mistreatment of painful LBBB syndrome may even cause secondary damage, such as VVS induced by sublingual NTG, which is usually used to alleviate angina.

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