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Int J Cardiol. 2019 Jul 15;287:181-188. doi: 10.1016/j.ijcard.2018.11.091. Epub 2018 Nov 18.

Role of autonomic nervous system in atrial fibrillation.

Author information

1
Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia. Electronic address: Dominik.Linz@adelaide.edu.au.
2
Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia.
3
Saarland University, Klinik für Innere Medizin III (Cardiology, Angiology and Intensive Care Medicine), Homburg, Saar, Germany.
4
University Maastricht, Dept. of Physiology, Maastricht, the Netherlands.
5
Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany.
6
Institute of Pharmacology, West German Heart and Vascular Center, University Duisburg-Essen, Essen, Germany; Department of Medicine, Montreal Heart Institute, Université de Montréal, Montréal, Quebec, Canada; Department of Pharmacology and Therapeutics, McGill University, Montreal, Quebec, Canada.
7
University Health Network and Sinai Health System Division of Cardiology, University of Toronto, Toronto, Ontario, Canada.

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.

KEYWORDS:

Atrial fibrillation; Autonomic nervous system; Hypertension; Renal denervation; Risk factors; Sleep apnea

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