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.