Vagal reflex provoked by radiofrequency catheter ablation in the right aortic sinus cusp: a Bezold–Jarisch-like phenomenon
ABSTRACT A 66-year-old woman with idiopathic premature ventricular contractions with a left bundle branch block QRS morphology and
left inferior axis underwent electrophysiologic testing. Successful radiofrequency ablation was achieved in the right coronary
cusp (RCC). However, radiofrequency ablation at sites adjacent to the successful ablation site provoked sinus bradycardia
followed by atrioventricular conduction block. That phenomenon might be explained by a vagal reflex through stimulation of
vagal pathways or receptors in the anterior epicardial fat pads neighboring to the RCC. A vagal reflex should be kept in mind
as a complication during catheter ablation of ventricular arrhythmias originating from the RCC.