CONGRESS ABSTRACT

Introduction Syncope is one of the main causes of access to the Emergency Department, outpatient visits and 1 to 3% of hospital admissions. Although benign events, even if sometimes traumatic, syncope causes a worsening of the quality of life of the patient and his/her family members, especially in the case of young patients who are otherwise in good health. Case Report A 19-year-old woman comes to the Syncope Unit of our Hospital with a history of syncopal episodes since the age of 12. Syncope, which occurred annually, never from exertion, was preceded by fleeting prodromes and occurred during normal daily activities. The patient often had minor trauma except in one case where a fracture of the mandible occurred. Over the years, the patient limited her activities for fear of syncope and was subjected to numerous diagnostic tests (EEG, Holter-ECG and echocardiogram) which were normal. A Head-up Tilt Test (HUTT) ​​performed two years ago had shown syncope with asystole of 12” considered to be of vasovagal nature and without indications for further measures. We repeated the HUTT with video support reproducing an asystolic syncope of 16”, after nitrate administration, which followed the asystole of about 3”. The syncopal episodes were therefore recurrent, sometimes traumatic, and significantly limiting daily life. Counterpressure maneuvers were ineffective for very brief prodromes, so, excluding cardiac stimulation in such a young patient, cardioneuroablation (CNA) was indicated. A Loop Recorder (ILR) was implanted to better characterize any further spontaneous syncopal episodes and for post-procedure follow-up, after a month, the ganglia were ablated with a only right-sided approach without complications and the patient was discharged on the first day. After one year, no syncopal recurrences occurred and no asymptomatic asystolic pauses were detected even during remote monitoring of the ILR. The frequency trend was characterized by a substantial stability on normal values ​​and no hyperkinetic arrhythmias were recorded. CNA requires further randomized studies, which are currently ongoing, and, if performed by experienced operators, is safe. A longer follow-up is certainly needed to study the efficacy over time and any late arrhythmic complications. Our patient, in the absence of syncopal events in the last 12 months, has progressively recovered a certain confidence in daily life, carrying out the activities typical of the routine of a nineteen-year-old.