Role of the Autonomic Nervous System in Atrial Fibrillation: Pathophysiology and Therapy
By Peng-Sheng Chen, Lan S. Chen, M. Fishbein, Shien‐Fong Lin, Stanley Nattel. Circulation Research, 2014
710 citations recorded by the source corpus.
Autonomic nervous system activation can induce significant and heterogeneous changes of atrial electrophysiology and induce atrial tachyarrhythmias, including atrial tachycardia and atrial fibrillation (AF). The importance of the autonomic nervous system in atrial arrhythmogenesis is also supported by circadian variation in the incidence of symptomatic AF in humans. Methods that reduce autonomic innervation or outflow have been shown to reduce the incidence of spontaneous or induced atrial arrhythmias, suggesting that neuromodulation may be helpful in controlling AF. In this review, we focus on the relationship between the autonomic nervous system and the pathophysiology of AF and the potential benefit and limitations of neuromodulation in the management of this arrhythmia. We conclude that autonomic nerve activity plays an important role in the initiation and maintenance of AF, and modulating autonomic nerve function may contribute to AF control. Potential therapeutic applications include ganglionated plexus ablation, renal sympathetic denervation, cervical vagal nerve stimulation, baroreflex stimulation, cutaneous stimulation, novel drug approaches, and biological therapies. Although the role of the autonomic nervous system has long been recognized, new science and new technologies promise exciting prospects for the future.
Subfields: Cardiology and Cardiovascular Medicine, Neurology
View Paper: https://www.semanticscholar.org/paper/c99899a2217b7c2581e1b74068b2203c92ac4bc9
How researchers see this paper
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In Cardiology and Cardiovascular Medicine
- Dobromir Petkov Dobrev
- Jason G. Andrade
- P. Khairy
- Stanley Nattel
- Gerhard Hindricks
- G. Raskob
- Aaron M. Wendelboe
Citations in the corpus
- The clinical profile and pathophysiology of atrial fibrillation: relationships among clinical features, epidemiology, and mechanisms. (2014, background): “Other articles in this compendium deal in detail with AF-related remodeling of atrial ion channel properties,(174) Ca handling,(174) and autonomic innervation.(175) Structural remodel-”
- 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. (2016, neutral): “Although the concept of Ca2+-handling instability has been challenged recently,(106,107) it may mediate AF in structurally remodelled atria and explain how altered autonomic tone can generate AF.(80,105)”
- EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication. (2016, neutral): “Thus, they are well positioned to affect atrial electrical activity in regions particularly important in AF, and their alteration by therapeutic manoeuvers like PV ablation may contribute to antiarrhythmic efficacy.(42,46,47)”
- 2017 HRS/EHRA/ECAS/APHRS/SOLAECE expert consensus statement on catheter and surgical ablation of atrial fibrillation (2017, background): “The latter might include interruption of crucial pathways of conduction between pulmonary-atrial junctions, which play a role in sustenance of AF, reduction of the amount of mass available for the number of simultaneously circulating wavelets (atrial debulking), or partial vagal denervation by inter”