Cardioneuroablation for the treatment of acute iatrogenic atrioventricular block during slow pathway ablation procedure

Atrioventricular nodal reentrant tachycardia (AVNRT) is a common paroxysmal supraventricular tachycardia, often treated with slow pathway (SP) ablation. Rarely, iatrogenic AV block occurs. In the present case, a 50-year-old male underwent SP ablation for recurrent symptomatic AVNRT. The procedure was complicated by long-lasting 2:1 nodal atrioventricular (AV) block. Cardioneuroablation (CNA) targeting the inferior paraseptal ganglionated plexus was attempted during the same procedure. Bi-atrial ablation suddenly restored a sustained 1:1 AV conduction. Follow-up at two months showed normal AV conduction without arrhythmia documentation. This case demonstrates, for the first time, the use of CNA to treat acute iatrogenic nodal AV block during index SP ablation. It highlights CNA’s potential to restore nodal function and avoid pacemaker implantation, potentially expanding its clinical indications beyond functional bradyarrhythmias. Central illustration. Conceptual framework of nodal-autonomic balance and treatment options . SAN, sinoatrial node; AVN, atrioventricular node; AV, atrioventricular; CNA, cardiopneuroablation. Take Home Messages : CNA may restore AV conduction in intrinsic nodal AV block, potentially representing a novel therapeutic strategy for young patients with nodal disturbances.