Advances in Arrhythmia and Electrophysiology

Recent Insights Into the Role of the Autonomic Nervous System in the Creation of Substrate for Atrial Fibrillation

Implications for Therapies Targeting the Atrial Autonomic Nervous System

In this review, we discuss recent developments in our understanding of the role of the autonomic nervous system in creating atrial fibrillation (AF) substrate and on how these findings relate to rapidly evolving therapeutic strategies (eg, ablation, surgery) to disrupt autonomic signaling in AF. AF is the most common sustained arrhythmia disturbance and is associated with significant morbidity and mortality. The morbidity and mortality associated with AF are especially increased in the setting of congestive heart failure (HF), with up to half of all patients with HF having concomitant AF.¹

Several mechanisms contribute to the electrophysiological and structural substrate of AF, including fibrosis, stretch, oxidative stress, and altered Ca²⁺-handling characteristics.² In addition, neurohumoral factors have been invoked for their possible contribution to the creation of AF substrate.  Read more