Abstract
Increased tone of the parasympathetic part of the autonomic nervous system, affecting the pacemaker cells, may cause sinus bradycardia, develop long pauses of heart rhythm, paroxysmal or permanent atrioventricular block followed by reflex syncope. The usual reflex syncope treatment is conservative and includes avoiding situations that trigger syncope (prolonged standing, sight of blood etc.), tilt-training, adequate drinking regime, wearing compression underwear, sleeping with the head of the bed elevated and in some cases stimulating neuro- and vegetotropic therapy. Some patients are refractory to conventional methods of treatment and retain severe symptoms that worsens quality of their life seriously. These patients may be required a pacemaker implantation subsequently. Cardioneuroablation is an alternative treatment in patients with overactive parasympathetic nervous system that is based on radiofrequency catheter ablation of the major parasympathetic autonomic ganglia around the heart.
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