Selective Cardioneuroablation for Swallow-Induced Atrioventricular Block: Mechanistic Insights of Ablation Therapy for Bradyarrhythmia.

BACKGROUND: Swallow-induced atrioventricular (AV) block is a rare mechanism of paroxysmal AV block, and no established curative treatment currently exists. CASE SUMMARY: A 75-year-old woman without known structural heart disease presented with symptomatic paroxysmal AV block during meals. Swallowing provocation test reproducibly induced AV block at the A-H level, which was suppressed following atropine administration, suggesting a vagally mediated reflex mechanism. Despite dietary counseling, her symptoms persisted; therefore, cardioneuroablation (CNA) was performed. Among the ganglionated plexi, sites demonstrating vagal responses during high-frequency stimulation, as well as anatomically defined ganglionated plexi regions, were selectively ablated. Following the procedure, no further swallow-induced paroxysmal AV block was observed. DISCUSSION: In this case, combined selective and anatomical CNA approach was used, targeting sites considered to provide parasympathetic input to the AV node. TAKE-HOME MESSAGE: Mechanism-based selective CNA may represent a promising therapeutic option for patients with swallow-induced AV block refractory to conservative management.