{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,7,30]],"date-time":"2025-07-30T11:49:55Z","timestamp":1753876195842,"version":"3.41.2"},"reference-count":7,"publisher":"Oxford University Press (OUP)","issue":"5","license":[{"start":{"date-parts":[[2024,5,16]],"date-time":"2024-05-16T00:00:00Z","timestamp":1715817600000},"content-version":"vor","delay-in-days":15,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2024,5,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Differentiation of syncope from seizure is challenging and has therapeutic implications. Cardioinhibitory reflex syncope typically affects young patients where permanent pacing should be avoided whenever possible. Cardioneuroablation may obviate the need for a pacemaker in well-selected patients.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Case summary<\/jats:title>\n                  <jats:p>A previously healthy 24-year-old woman was referred to the emergency department after recurrent episodes of transient loss of consciousness (TLOC). The electrocardiogram (ECG) and the echocardiogram were normal. An electroencephalogram (EEG) showed intermittent, generalized pathological activity. During EEG under photostimulation, the patient developed a short-term TLOC followed by brachial myocloni, while the concurrent ECG registered a progressive bradycardia, which turned into a complete atrioventricular block and sinus arrest with asystole for 14\u2005s. Immediately after, the patient regained consciousness without sequelae. The episode was interpreted as cardioinhibitory convulsive syncope. However, due to the pathological EEG findings, an underlying epilepsy with ictal asystole could not be fully excluded. Therefore, an antiseizure therapy was also started. After discussing the consequences of pacemaker implantation, the patient agreed to undergo a cardioneuroablation and after 72\u2005h without complications, she was discharged home. At 10 months, the patient autonomously discontinued the antiepileptics. The follow-up EEG displayed unspecific activities without clinical correlations. An implantable loop recorder didn\u2019t show any relevant bradyarrhythmia. At 1-year follow-up, the patient remained asymptomatic and without syncopal episodes.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Discussion<\/jats:title>\n                  <jats:p>Reflex syncope must be considered in the differential diagnosis of seizures. The cardioneuroablation obviated the need for a pacemaker and allowed for the withdrawal of anticonvulsants, originally started on the premise of seizure.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/ehjcr\/ytae256","type":"journal-article","created":{"date-parts":[[2024,5,15]],"date-time":"2024-05-15T21:06:17Z","timestamp":1715807177000},"source":"Crossref","is-referenced-by-count":0,"title":["Syncope or seizure: that is the question\u2014case report of a young patient with convulsive cardioinhibitory syncope treated with cardioneuroablation"],"prefix":"10.1093","volume":"8","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6770-0173","authenticated-orcid":false,"given":"Andrea","family":"Papa","sequence":"first","affiliation":[{"name":"Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel , Basel , Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1557-9062","authenticated-orcid":false,"given":"Urs","family":"Fisch","sequence":"additional","affiliation":[{"name":"Department of Neurology, University Hospital Basel , Basel , Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1729-1425","authenticated-orcid":false,"given":"Stefano","family":"Bassetti","sequence":"additional","affiliation":[{"name":"Division of Internal Medicine, University Hospital Basel and University of Basel , Basel , Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9751-0557","authenticated-orcid":false,"given":"Patrick","family":"Badertscher","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel , Basel , Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4367-2363","authenticated-orcid":false,"given":"Philipp","family":"Krisai","sequence":"additional","affiliation":[{"name":"Department of Cardiology and Cardiovascular Research Institute Basel, University Hospital Basel , Basel , Switzerland"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2024,5,16]]},"reference":[{"key":"2024052806073018300_ytae256-B1","doi-asserted-by":"crossref","first-page":"1883","DOI":"10.1093\/eurheartj\/ehy037","article-title":"2018 ESC guidelines for the diagnosis and management of syncope","volume":"39","author":"Brignole","year":"2018","journal-title":"Eur Heart J"},{"key":"2024052806073018300_ytae256-B2","doi-asserted-by":"crossref","first-page":"128","DOI":"10.4103\/apc.APC_105_20","article-title":"The slow-flat-slow sequence in malignant vasovagal syncope","volume":"14","author":"Vaksmann","year":"2021","journal-title":"Ann Pediatr Cardiol"},{"key":"2024052806073018300_ytae256-B3","doi-asserted-by":"crossref","first-page":"181","DOI":"10.1016\/S0735-1097(00)00700-2","article-title":"Misdiagnosis of epilepsy: many seizure-like attacks have a cardiovascular cause","volume":"36","author":"Zaidi","year":"2000","journal-title":"J Am Coll Cardiol"},{"key":"2024052806073018300_ytae256-B4","doi-asserted-by":"crossref","first-page":"3427","DOI":"10.1093\/eurheartj\/ehab364","article-title":"2021 ESC guidelines on cardiac pacing and cardiac resynchronization therapy","volume":"42","author":"Glikson","year":"2021","journal-title":"Eur Heart J"},{"key":"2024052806073018300_ytae256-B5","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1016\/j.eupc.2004.10.003","article-title":"Cardioneuroablation\u2019\u2014new treatment for neurocardiogenic syncope, functional AV block and sinus dysfunction using catheter RF-ablation","volume":"7","author":"Pachon","year":"2005","journal-title":"Europace"},{"key":"2024052806073018300_ytae256-B6","first-page":"33","article-title":"Cardioneuroablation in the treatment of neurally mediated reflex syncope: a review of the current literature","volume":"45","author":"Aksu","year":"2017","journal-title":"Turk Kardiyol Dern Ars"},{"key":"2024052806073018300_ytae256-B7","first-page":"85","article-title":"Cardioneuroablation for reflex syncope","volume":"9","author":"Piotrowski","year":"2023","journal-title":"JACC: Clin Electrophysiol"}],"container-title":["European Heart Journal - 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