The Intrinsic Autonomic Nervous System in Atrial Fibrillation: A Review

He, Bo; Scherlag, Benjamin J.; Nakagawa, Hiroshi; Lazzara, Ralph; Po, Sunny S.

doi:10.5402/2012/490674

Cited by 16 publications

(7 citation statements)

References 77 publications

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“…Activation of the parasympathetic and/or sympathetic limbs can provoke atrial arrhythmias (108, 116). Acetylcholine activates a specific potassium current, I K,ACh , that heterogeneously shortens atrial action potential duration and refractoriness, increasing susceptibility to reentry.…”

Section: Background and Pathophysiologymentioning

confidence: 99%

2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation

January¹,

Wann²,

Alpert³

et al. 2014

Circulation

3,570

1,139

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Section: Background and Pathophysiologymentioning

confidence: 99%

2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation

January¹,

Wann²,

Alpert³

et al. 2014

Circulation

3,570

1,139

View full text Add to dashboard Cite

“…119 Others used an anatomically based approach without high-frequency stimulation. 120, 121 Because ganglionated plexus ablation is a new procedure, it is possible that there is a bias in favor of reporting positive results. Katritsis et al 122 performed a prospective randomized clinical trial, exposing 242 patients with PAF to pulmonary vein isolation alone, ganglionated plexus ablation alone (anatomical approach) and pulmonary vein isolation plus ganglionated plexus ablation.…”

Section: Neuromodulation As a Therapeutic Approachmentioning

confidence: 99%

Role of the Autonomic Nervous System in Atrial Fibrillation

Chen

Fishbein

et al. 2014

Circulation Research

616

493

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Autonomic nervous system activation can induce significant and heterogeneous changes of atrial electrophysiology and induce atrial tachyarrhythmias, including atrial tachycardia (AT) 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. While the role of the autonomic nervous system has long been recognized, new science and new technologies promise exciting prospects for the future.

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“…The intrinsic cardiac autonomic nervous system (ICANS) is composed of several ganglia plexus and interconnected nerve or neurons [ 2 – 5 ]. The influence of the exogenous and endogenous nerve stimulation plexus ablation on pulmonary vein sleeves and atrial myocardium provides important information needed to understand the occurrence and persistence of AF [ 6 – 9 ]. However, detailed studies on the occurrence and maintenance of AF are lacking.…”

Section: Introductionmentioning

confidence: 99%

Atrial Fibrillation Electrical Remodelling via Ablation of the Epicardial Neural Networks and Suprathreshold Stimulation of Vagosympathetic Nerve

Sun

Zhou

et al. 2015

Med Sci Monit

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BackgroundNumerous studies have shown that the cardiac autonomic nervous system (CANS) is involved in the occurrence and persistence of atrial fibrillation (AF). The CANS is commonly considered to consist of the extrinsic and intrinsic autonomic nerves. The influence of exogenous and endogenous nerve stimulation plexus ablation on pulmonary vein sleeves and atrial myocardium provides important information in understanding the occurrence and persistence of AF. Vagosympathetic nerve stimulation and epicardial neural networks are important participants in atrial electrical remodelling (AER). Elucidation of the changes in the electrophysiological indicators of the atrial and pulmonary veins caused by epicardial neural network ablation and autonomic nerve stimulation may provide a theoretical basis for the clinical treatment of AF.Material/MethodsA total of 13 beagle dogs were randomly divided into 2 groups: the control group (n=6), which was treated with a simple rapid atrial pacing (RAP) for 6 h, and the experimental group (n=7), which was treated with RAP+vagus nerve stimulation (VNS) for 6 h. Both groups were treated with epicardial ganglia plexus (GP) ablation after 6 h. We measured the monophasic action potential (MAP), various parts of the effective refractory period (ERP), and AF induction rate before and after pacing or ablation.ResultsWith the extension of the pacing time, the atrial MAP and ERP of the 2 groups shortened and returned to normal after ablation plexus. After GP ablation, the atrial AF-induced rate did not decrease significantly compared with that of the pulmonary vein.ConclusionsVagus nerve threshold stimulation exacerbated the deterioration of electrical remodelling, whereas the epicardial neural network ablation blocked or reversed the AER.

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The Intrinsic Autonomic Nervous System in Atrial Fibrillation: A Review

Cited by 16 publications

References 77 publications

2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation

2014 AHA/ACC/HRS Guideline for the Management of Patients With Atrial Fibrillation

Role of the Autonomic Nervous System in Atrial Fibrillation

Atrial Fibrillation Electrical Remodelling via Ablation of the Epicardial Neural Networks and Suprathreshold Stimulation of Vagosympathetic Nerve

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