Reply to the Editor— Cardiac denervation and its consequences in heart disease
We appreciate the thorough review of our article1 by Rivarola and Scanavacca. Interest in autonomic modulation during pulmonary vein isolation (PVI) arose from the observation of atrioventricular block or “vagal effects” during ablation. This birthed the idea that PVI might inadvertently and inconsistently affect the “autonomic system” and the outcome of PVI. However, it is crucial to note that cardioneuroablation (CNA) deliberately destroys ganglionated plexi rather than accidentally doing so. Complete CNA, as performed in our study, results in vagal denervation confirmed by histology and direct vagal stimulation.