Empirical anatomic ablation
This strategy can be used in 2 different ways: adjunctive to electrogram
analysis or HFS (44) or both; or as a true stand-alone strategy, via
isolated right atrial or left atrial approaches (48, 62). Sun et al (48)
compared HFS-guided and empirically defined ablation approaches in 57
VVS cases. No statistical differences were found between HFS-guided and
anatomical-guided ablation groups in either freedom from syncope or
recurrent prodromes.
Future implications
The optimal approach to modulate the intrinsic cardiac ANS, the number
of sGPs to be targeted and the long-term consequences of these therapies
remain unclear. It is important to
note that intrinsic cardiac ANS modulation can be associated with
procedural risks, either in terms of procedural complications or the
potential for off target effects like enhanced susceptibility to
ventricular arrhythmias (66). Given the very complicated and variable
distribution of epicardial ganglia and sGPs in humans, further
characterization of the hierarchy of sGPs and specific atrial sGPs that
ought to be targeted for arrhythmia therapy will be crucial. Until we
get more data from prospective randomized studies, it is reasonable to
proceed with caution in ablating these structures.