LVHN Is First in Region to Offer New Treatment for Vasovagal Syncope

Vasovagal syncope, also known as neurocardiogenic or neurally mediated syncope, can lead to recurrent episodes of fainting caused by excessive activity in the vagus nerve, leading to significant bradycardia or asystole for several seconds and/or hypotension.

Treatment for this condition is somewhat limited and usually aimed at avoidance techniques and liberalization of salt and fluid intake. Pharmacological therapy for the management of the hypotension aspect does exist; however, it does not for the bradycardia or asystole episodes. Implanting a pacemaker may relieve the condition. However, lifelong pacemaker therapy is not an ideal solution for a young person without other cardiac issues. In fact, the American College of Cardiology recommends a pacemaker for vasovagal syncope associated with symptomatic pauses only for people older than age 40.

Enter cardioneural ablation, a new treatment option for young adults who experience recurrent fainting associated with pauses in their heartbeat but who are otherwise free of heart disease. Lehigh Valley Heart and Vascular Institute is the only health center in the region – and one of just a handful in the nation – to offer this novel procedure.

“One of my recent patients was a 29-year-old male with a six-year history of fainting episodes,” says Sergio Cossu, MD, a cardiac electrophysiologist at the Heart and Vascular Institute. “In one fainting episode, he had hit his head, sustaining a traumatic brain injury and subarachnoid hemorrhage. At that point, he lost his driver’s license.”

“Now, six months after undergoing cardioneural ablation, he has not experienced any further fainting episodes,” Dr. Cossu continues. “He is feeling great, with no further dizziness or lightheadedness, and we will be able to restore his driving privileges.”

Cardioneural ablation employs a cardiac ablation technique similar to that used for atrial fibrillation. The treatment target is different, however. In cardioneural ablation, a catheter is threaded into the heart, where heat (radiofrequency energy) is used to destroy ganglionated plexi, nerve endings in the right and left atria that are innervated by the vagus nerve. “Essentially, we are blocking communication between the vagus nerve and the heart,” Dr. Cossu says.

For the right individuals, many of whom have been living with fear and frustration for years due to repeated fainting, the potential benefits are substantial. “By removing vagal input, we may mitigate the need for a pacemaker,” Dr. Cossu says. “More importantly, we may eliminate the malignant episodes of syncope.”

Cardioneural ablation is specifically intended for people with vasovagal syncope who present with a cardioinhibitory response (heart pauses). In contrast, it is not appropriate for those who present with a vasodepressor response (sudden drops in blood pressure accompanied by little change in heart rate).

Dr. Cossu uses a Holter monitor or implantable loop recorder to document heart pauses prior to performing cardioneural ablation.

“Young patients with vasovagal syncope should be referred for evaluation to determine whether they may benefit from this new treatment option,” he says.