Permanent Pacemaker Implantation or Cardioneuroablation in Sinus Node Dysfunction

Inclusion Criteria: * Age, 18-75 years * Sinus node dysfunction/disease fulfilling criteria for elective pacemaker implantation according to current ESC guidelines (I, IIa, and IIb ) * Optimization of chronic disease treatment * Ability to provide informed consent to participate in the study * Ability to understand patient information. Exclusion Criteria: * Contraindications to invasive and noninvasive procedures used in the study * Uncontrolled endocrine and systemic disorders * Persistent atrial fibrillation * Dilated cardiomyopathy * Severe congenital heart valve disease or cardiomyopathy * Functional NYHA class III/IV * Left ventricular ejection fraction \<35% * Left atrial diameter \>50 mm * Previous catheter ablation * Contraindications to anticoagulant treatment * Contraindications to catheter ablation * Chronic, advanced two- or third-degree atrioventricular block associated with structural heart disease * Contraindications to noninvasive tests * Pregnancy and lactation * Previous cardiac surgery * Implanted pacemaker device * Neck and chest abnormalities * Myocardial infarction in the previous 6 months * Percutaneous coronary intervention in the previous 3 months * Estimated survival \<24 months * Participation in another drug or medical device program * Limited capacity to understand the study protocol or psychological disorders precluding informed consent to participate in the study. * Any other uncontrolled chronic diseases, neck and chest abnormalities, or dis…