Background Sleep-related bradyarrhythmia is often overlooked due to the absence of symptoms and are now mostly believed to be related to excessive vagal nerve tension. The choice of treatment still remains controversial. Ganglionated plexus (GP) ablation, as an experimental therapeutic approach, could be effective for some cases. Case summary We report a case of 41-year-old male with recurrent nocturnal ventricular asystole up to 10.1 seconds related to advanced atrioventricular block, in whom sleep apnea syndrome was excluded. Echocardiography, thyroid function test levels, coronary angiography and transesophageal electrophysiological test were normal. Considering that this significant nocturnal bradyarrhythmia is associated with increased vagal tone and decreased sympathetic activity, and the patient refused pacemaker implantation, we proceeded with GP ablation in the left atrial for the patient. After ablation, the patient’s nocturnal advanced atrioventricular block completely disappeared. Holter monitoring revealed heart rate variability analysis data consistent with successful vagal plexus ablation. Conclusion It seems like GP ablation is a safe and effective treatment for functional sleep-related bradyarrhythmia. Currently, we found 2 cases on nocturnal bradyarrhythmia from all relevant literatures, among which vagal ganglion ablation was successfully performed with favorable therapeutic effects. The case we report now may be the third one. Interestingly, the three cases that opted for GP ablation also differed in the selection of ablation sites. All three cases achieved significant therapeutic effects after ablation, and the selection of ablation methods needs further investigation. Further research is needed to elucidate the pathophysiological mechanisms underlying this autonomic disorder, and long-term follow-up is required to evaluate its sustained therapeutic efficacy.
