Role of autonomic nervous system in atrial fibrillation

• Published in: International journal of cardiology Vol. 287; pp. 181 - 188
• Main Authors: Linz, Dominik, Elliott, Adrian D., Hohl, Mathias, Malik, Varun, Schotten, Ulrich, Dobrev, Dobromir, Nattel, Stanley, Böhm, Michael, Floras, John, Lau, Dennis H., Sanders, Prashanthan
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier B.V 15.07.2019
• Subjects: Atrial fibrillation; Atrial Fibrillation - physiopathology; Atrial Fibrillation - surgery; Autonomic nervous system; Autonomic Nervous System - physiopathology; Autonomic Nervous System - surgery; Heart Atria - innervation; Heart Atria - physiopathology; Heart Rate - physiology; Humans; Hypertension; Renal denervation; Risk Factors; Sleep apnea; Sympathectomy - methods; Hypertension; Renal denervation; Sleep apnea; Autonomic nervous system; Atrial fibrillation; Risk factors
• ISSN: 0167-5273; 1874-1754
• DOI: 10.1016/j.ijcard.2018.11.091

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. •Combined sympathetic and vagal activation creates an atrial fibrillation substrate.•Autonomic nervous system activity is contributed by common concomitant risk factors.•Transient autonomic activation contributes to a dynamic atrial fibrillation substrate.•Autonomic nervous system and atrial fibrillation: a bidirectional relationship•Combined risk factor management can modify the autonomic nervous system.