Reply to the Editor- Treatment of asystole caused by vagal nerve stimulator.

We thank Drs Antolic and Zizek for their thoughtful review of our case report on the use of a permanent pacemaker in a patient with late-onset asystolic episodes related to use of a nerve stimulator.

Cardioneuroablation is a new technology in which the autonomic ganglion in the left atrium is targeted for denervation as a treatment for neurally mediated syncope, asystolic, and postictal syncope. The data are limited, based on small observational studies and case reports2, 3, 4, 5; no randomized controlled trial has been completed yet.

Alteration in autonomic function can lead to deleterious effects on the heart, such as arrhythmias and sudden cardiac death, which are unknown in this patient population.