Cardioneuroablation for Pediatric Vasovagal Syncope Guided by Peak Frequency Mapping.

BACKGROUND: The management of refractory vasovagal syncope (VVS) in young patients presents a challenge, and cardioneuroablation (CNA) is a potential alternative. Real-time peak frequency (PF) spectral mapping with continuous-wavelet transform enables precise localization of ganglionated plexi. CASE SUMMARY: A 12-year-old woman who presented with mixed-type VVS underwent CNA. Electroanatomic mapping was performed using a mapping system equipped with omnipolar technology near field. PF maps identified the right superior, right inferior, and posteromedial left ganglionated plexi, which were subsequently ablated. Postablation electrophysiological evaluation improved significantly. During the 3-month follow-up, the patient remained free of syncope. DISCUSSION: This case details the first stand-alone application of omnipolar technology near field-based PF mapping to guide CNA in a pediatric patient with VVS. It demonstrates the feasibility of this precise technique, providing a methodological reference for pediatric CNA. TAKE-HOME MESSAGE: In young patients with VVS, CNA guided by PF mapping is a viable strategy.