Optimizing cardioneuroablation candidate selection: a case report using tilt-table testing with Russo’s Fast Italian Protocol

Cardioneuroablation (CNA) has emerged as a promising therapeutic alternative to conventional pacing therapy for vasovagal syncope (VVS). Accurate patient selection and diagnosis are crucial for achieving optimal outcomes. The lack of a universally accepted protocol specifically tailored for selecting patients for CNA presents a gap in the current guidelines.

This case is about a 44-year-old male with recurrent severe syncope. Head-up tilt-table testing utilizing the newly established Fast Italian Protocol (FIP) by Russo et al. revealed a cardioinhibitory vasovagal response, traditionally managed with pacemaker therapy. The patient, however, opted for CNA. Targeted radiofrequency ablation of the ganglionated plexi in the right and left atria was successfully performed. Clinical follow-up at 12 months post-ablation revealed no recurrence of syncopal episodes.

This case highlights the utility of tilt testing and the efficacy of the FIP as an efficient diagnostic tool for evaluating cardioinhibitory vagal responses. It supports its role in patient selection for CNA and additionally presents a promising option for a non-invasive follow-up assessment, though further investigation is needed. Its simplicity and efficiency position it as a promising candidate for standardization as the primary diagnostic tool in CNA workflows.