Abstract
Atrial fibrillation is the most common sustained arrhythmia and is associated with significant morbidity and mortality. The autonomic nervous system has a significant role in the milieu predisposing to the triggers, perpetuators and substrate for atrial fibrillation. It has direct electrophysiological effects and causes alterations in atrial structure. In a significant portion of patients with atrial fibrillation, the autonomic nervous system activity is likely a composite of reflex excitation due to atrial fibrillation itself and contribution of concomitant risk factors such as hypertension, obesity and sleep-disordered breathing. We review the role of autonomic nervous system activation, with focus on changes in reflex control during atrial fibrillation and the role of combined sympatho-vagal activation for atrial fibrillation initiation, maintenance and progression. Finally, we discuss the potential impact of combined aggressive risk factor management as a strategy to modify the autonomic nervous system in patients with atrial fibrillation and to reverse the arrhythmogenic substrate. (c) 2018 Elsevier B.V. All rights reserved.
Original language | English |
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Pages (from-to) | 181-188 |
Number of pages | 8 |
Journal | International Journal of Cardiology |
Volume | 287 |
DOIs | |
Publication status | Published - 15 Jul 2019 |
Keywords
- Autonomic nervous system
- Atrial fibrillation
- Sleep apnea
- Hypertension
- Risk factors
- Renal denervation
- STELLATE GANGLION
- HEART-FAILURE
- LOW-LEVEL
- MECHANISMS
- STIMULATION
- DENERVATION
- REFLEX
- VAGAL
- REFRACTORINESS
- RECURRENCES