Introduction:
Bradyarrhythmias manifested as sinus arrest, sinus bradycardia, brady-tachy syndrome, transient atrioventricular (AV) block or cardioinhibitory syncope can be associated with autonomic imbalance, for which parasympathetic drive predominates. In these cases, specially in younger patients, this poses a conundrum when it comes to decisions whether and how to treat. Increasing evidence, also states a role of vagal tone in some patients with atrial fibrillation (AF), as parasympathetic stimulation is known to shorten atrial effective refractory period and increases the probability of multiple reentrant circuits in the atrial myocardium, therefore increasing stability of atrial fibrillation (1,2,3). An increasing number of studies (3,4,5,6,7,8,9) have convincingly shown that parasympathetic cardiac modulation is an alternative and effective therapeutic method for the treatment of these patients, although there is no standardized technique or endpoint criteria to assess therapeutic success.
The objective of this study was to understand if performing a simplified, purely anatomic guided ablation aiming only at the atrial right GP proves to be a valid and successful strategy to perform cardiac modulation in patients with significant functional bradyarrhythmias.