Study limitations:
This is a study with a small number of patients and therefore larger
prospective studies are needed to validate the strategy of performing
ablation of only the right GP with a purely anatomic technique.
Interestingly, it would be of value a larger study aiming at ablation of
just the interatrial septum, for it seems to be the most effective site
for cardiac parasympathetic denervation among these patients.
In spite no immediate effect on HR was noted during PVI in the 4
patients that had ablation for AF, we cannot exclude a possible
additional effect of concurrent inadvertent left GP ablation in these
patients.
Likewise, the long term effects of cardiac parasympathetic denervation
are unknown and there are reports of coronary artery spasm or
ventricular tachycardia after ablation (15), probably
by means of increased sympathetic tone, and it would be of utmost
importance a larger study with longer follow up times in order to
understand the safety outcomes of these procedures.