Autonomic Modulation of Atrial Fibrillation

Tsai, Wei–Chung; Hung, Tsung-I; Kusayama, Takashi; Han, Seongwook; Fishbein, Michael C.; Chen, Lan S.; Chen, Peng‐Sheng

doi:10.1016/j.jacbts.2023.03.019

Cited by 6 publications

(2 citation statements)

References 71 publications

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“…Thoracic subcutaneous nerve originates primarily from the SG ( 51 ). Stimulating the subcutaneous sympathetic nerves in the area or the sympathetic component within the vagal nerve may also be effective in treating AF ( 52 ). Some studies suggest that low-intensity (0.25 mA) ScNS results in increased cardiac sympathetic sprouting, elevated plasma NE concentrations, and prolonged AT duration leading to arrhythmias, whereas the opposite effect is observed with high-intensity (2.5 and 3.5 mA) stimulation ( 53 ).…”

Section: Neuromodulation Methods For Afmentioning

confidence: 99%

Development of neuromodulation for atrial fibrillation: a narrative review

Yang,

Zou,

Wen

et al. 2024

J Thorac Dis

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Background and Objective Atrial fibrillation (AF) is a prevalent clinical arrhythmia with a high incidence of disability and mortality. Autonomic nervous system (ANS) plays a crucial role in the onset and persistence of AF, and can lead to electrophysiological changes and alterations in atrial structure. Both animal models and clinical findings suggest that parasympathetic and sympathetic activity within the cardiac ANS could induce atrial remodeling and AF. Remodeling of the cardiac autonomic nerves is a significant structural basis for promoting AF. Given the challenges faced by conventional pharmacological and atrial ablation techniques in the treatment of AF, increasing attention has been paid to autonomic intervention strategies for AF. Current research has demonstrated that the frequency and severity of AF episodes can be significantly reduced by modulating the activity of ANS. ANS neuromodulation is expected to lead more effective and personalized treatment options for patients with AF. The objective of this review is to provide a broader perspective for future related studies by reviewing preclinical and clinical studies of neuromodulation methods for the treatment of AF, searching for relevant approaches to treat AF, as well as identifying the strengths and weaknesses demonstrated by current relevant studies, and providing researchers with a broader overview of the latest neurological treatments for AF. Methods A narrative review was conducted on the literature on PubMed, WanFang data, and Google Scholar, including all relevant studies published until November 2023. Key Content and Findings In this review, we delve into the innervation of cardiac autonomic nerves, the role of the ANS in the development and maintenance of AF, and the current neuromodulation methods for AF treatment. These methods include stellate ganglion (SG) resection or ablation, vagus nerve stimulation (VNS), thoracic subcutaneous nerve stimulation (ScNS), renal denervation (RDN) therapy, ganglionated plexus (GP) ablation, and epicardial botulinum toxin or CaCl 2 injection. More and more research suggests that neuromodulation methods for the treatment of AF have broad prospects. Conclusions ANS plays a crucial role in AF development and maintenance through cardiac autonomic nerve remodeling. Modulating ANS activity can significantly reduce AF frequency and severity, offering more personalized treatment options. Current research on autonomic interventions for AF shows promise for more effective and personalized treatments.

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Section: Neuromodulation Methods For Afmentioning

confidence: 99%

Development of neuromodulation for atrial fibrillation: a narrative review

Yang,

Zou,

Wen

et al. 2024

J Thorac Dis

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“…Furthermore, the rapid ventricular rate in patients with AF impairs myocardial perfusion by decreasing diastolic coronary blood flow, eventually causing or worsening myocardial ischemia [24]. Moreover, AF is associated with hyperactivity of the sympathetic nervous system (SNS), which is per se considered another fundamental mechanism that triggers the progression of HF [25,26]. Last but not least, AF is correlated with increased aortic stiffness, which in turn leads to increased LV afterload and elevated peripheral vascular resistance, both of which further compromise cardiac performance and pose an additional risk of HF exacerbation [27].…”

Section: Af As the Triggering Factor Of Ahfmentioning

confidence: 99%

The Optimal Management of Patients with Atrial Fibrillation and Acute Heart Failure in the Emergency Department

Velliou,

Sanidas,

Diakantonis

et al. 2023

Medicina

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Atrial fibrillation (AF) and acute heart failure (AHF) are two closely interrelated conditions that frequently coexist in a manifold manner, with AF serving either as the causative factor or as the consequence or even as an innocent bystander. The interplay between these two clinical conditions is complex, given that they share common pathophysiological pathways and they can reciprocally exacerbate each other, thus triggering a vicious cycle that worsens the prognosis and increases the thromboembolic risk. The optimal management of AF in the context of AHF in the emergency department remains a challenge depending on the time onset, as well as the nature and the severity of the associated symptoms. Acute rate control, along with early rhythm control, when indicated, and anticoagulation represent the main pillars of the therapeutic intervention. The purpose of this review is to elucidate the pathophysiological link between AF and AHF and accordingly present a stepwise algorithmic approach for the management of AF in AHF patients in the emergency setting.

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