Cardioneural and accessory atrioventricular pathway ablation for vagally mediated atrial fibrillation in PRKAG2 syndrome.
Caroline B Ledet, Kyle Steiger, Anthony H Kashou et al.
✦ AI-curated · Sources linked
Case in brief
A young patient with PRKAG2-mediated cardiomyopathy experienced refractory paroxysmal atrial fibrillation (AF) despite previous accessory atrioventricular pathway ablation. AF episodes were consistently triggered by cold milk ingestion. Electrophysiology study revealed vagally mediated mechanisms, leading to repeat ablation and cardioneural ablation (CNA). Follow-up showed elimination of vagally mediated sinus pauses and a reduction in pacing burden to 0%, with only low-burden asymptomatic AF remaining.
What made this case unusual
The case highlights the unique interaction between vagal tone and underlying conduction disease, with AF episodes triggered specifically by cold milk ingestion.
Diagnostic / clinical pearl
Clinicians should consider the role of vagal tone in arrhythmias, especially in patients with underlying conduction system disease, as it may necessitate tailored ablation strategies.
Why it matters
Understanding the vagal triggers in arrhythmias can lead to more effective management strategies in patients with complex underlying conditions like PRKAG2 syndrome.