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.