Future implications
Some important questions remain unanswered. Long‐term outcomes of GP
ablation over a 5‐year horizon or longer have not yet been reported.
Randomized controlled trials comparing CNA and conservative therapy, and
between CNA and pacing are required to demonstrate efficacy and safety
of the technique. Because positive results of pacemaker implantation
demonstrated a powerful placebo/expectation effect in the VVS
population, there are similar concerns with CNA, and sham-controlled
trials may help to quantify the placebo effect. Finally, it should be
kept in mind that neuromodulation of ANS might be associated with
procedural risks, either in terms of procedural complications or the
potential for off‐target effects like enhanced susceptibility to
ventricular arrhythmias (35). Until we collect more data from
prospective randomized studies, it is reasonable to proceed with caution
in ablating these structures.