Role of autonomic nervous system in atrial fibrillation

Dominik Linz*, Adrian D. Elliott, Mathias Hohl, Varun Malik, Ulrich Schotten, Dobromir Dobrev, Stanley Nattel, Michael Boehm, John Floras, Dennis H. Lau, Prashanthan Sanders

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

54 Citations (Web of Science)

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 languageEnglish
Pages (from-to)181-188
Number of pages8
JournalInternational Journal of Cardiology
Volume287
DOIs
Publication statusPublished - 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

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