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.