Introduction: Some patients suffer recurrent syncope following
cardioneuroablation (CNA) for vasovagal syncope (VVS), yet no cases of
repeat CNA have been described in detail. Methods and Results: Our
present patient suffered a recurrence seven months following successful
CNA and wished for a repeat CNA. Pre-procedurally, she lacked an
atropine response. During CNA, high-frequency stimulation (HFS) at
ganglionated plexi (GP) would not trigger cardioinhibitory events.
Ablation was delivered based on anatomy and fractionation mapping,
producing characteristic tachycardia at 2 GP sites. Conclusion: Repeat
CNA is feasible and safe, and characterized by unique physiology.