Cardioneuroablation Restoring Atrioventricular Conduction in Brugada Syndrome

BACKGROUND: Brugada syndrome (BrS), traditionally associated with ventricular arrhythmic risk, may also involve conduction disturbances. SCN5A deleterious variants predispose to bradyarrhythmias and atrioventricular block, posing the challenge of pacemaker implantation in young patients. CASE SUMMARY: A 17-year-old girl with BrS and SCN5A p.(Glu901Lys) pathogenic variant presented with recurrent presyncope, dyspnea, and more than 3,000 second-degree atrioventricular blocks documented on 24-hour Holter monitoring. Atropine administration reversed the block, confirming a functional origin. Biatrial approach cardioneuroablation (CNA) guided by electroanatomical mapping without fluoroscopy restored normal conduction and improved sinus rate. After 12 months, the patient remained asymptomatic and free of bradyarrhythmias. DISCUSSION: CNA restores autonomic balance and corrects functional bradyarrhythmias in BrS, avoiding permanent pacing. Success of CAN depends on accurate identification of the functional mechanism and expertise in autonomic mapping. TAKE-HOME MESSAGES: In BrS, vagally mediated functional bradyarrhythmias may respond to atropine testing. CNA offers a physiological and durable alternative to pacemaker implantation in young patients with functional atrioventricular block.