Modulation of Autonomic Nervous Activity in the Termination of Paroxysmal Atrial Fibrillation

Abstract

Autonomic changes critically regulate termination of PAF, which is modulated by aging.

Autonomic modulation before and after paroxysmal atrial fibrillation events in patients with ischemic heart disease

“…Multiple studies have investigated the patterns of spontaneous AF termination (Alcaraz, Rieta, & Hornero, 2008; Chiarugi, Varanini, Cantini, Conforti, & Vrouchos, 2007; Huang et al., 2017; Lin, Chang, Eatock, Galla, & Clayton, 2017; Ndrepepa et al., 2002; Nilsson, Stridh, Bollmann, & Sörnmo, 2006). However, the results have not been unanimous.…”

“…Huang et al. (2017) demonstrated that major autonomic changes in 65% of PAF terminations were caused by sympathetic activation and parasympathetic withdrawal by analyzing the normalized LF and HF. Our findings of autonomic changes in both groups only presented a significant reduction in the parasympathetic activity, which was only partly consistent with the study because we did not observe any sympathetic activation after the termination.…”

“…Additionally, when it comes to the HRV analysis after the termination of PAF events, Tomita et al (2003) showed that PAF events initiated in the daytime terminated with decreases in the LF and LF/ HF ratio; on the contrary, PAF events initiated at night terminated with both an LF and HF decrease. Huang et al (2017) demonstrated that major autonomic changes in 65% of PAF terminations were caused by sympathetic activation and parasympathetic withdrawal by analyzing the normalized LF and HF. Our findings of autonomic changes in both groups only presented a significant reduction in the parasympathetic activity, which was only partly consistent with the study because we did not observe any sympathetic activation after the termination.…”

“…Several publications have shown that both the sympathetic and parasympathetic nervous systems play crucial roles in the initiation and maintenance of AF (Bettoni & Zimmermann, 2002; Dimmer et al., 1998; Gallo et al., 2017; Herweg, Dalal, Nagy, & Schweitzer, 1998; Huang et al., 2017; Huang, Wen, Lee, Chang, & Chen, 1999; Lombardi et al., 2004; Tomita et al., 2003; Vincenti, Brambilla, Fumagalli, Merola, & Pedretti, 2006). A shift toward an increase in the sympathetic tone and loss of the parasympathetic tone seems to initiate PAF events in patients with structural heart disease, whereas most idiopathic and nocturnal PAF episodes are parasympathetic predominant (Huang et al., 1999, 2017; Tomita et al., 2003).…”

Time-dependent Cervical Vagus Nerve Stimulation and Frequency-dependent Right Atrial Pacing Mediated Inducibility of Atrial Fibrillation

“…Lemola et al (6) demonstrated that intact PVs are not required for the maintenance of experimental vagal AF and ganglionated plexi ablation may suppress the vagal response and prevent AF, indicating the importance of the ANS in the pathogenesis of AF. Although the association between cardiac innervation of the ANS from the brain and AF induction was well established during the last century (7), a majority of recent studies have focused on the roles of the ANS in terms of the mechanism (8-13) and/or treatment of AF (7, 14-18). Many theories have been proposed to explain the roles of the cardiac autonomic nervous system (CANS) in arrhythmia initiation and progression such as “The Third Fat Pad,” (8) “Integration Center,” (19, 20) “Octopus” hypothesis, (9) “Little brain,” (10) and “Autonomic remodeling” (12); however, the roles of the CANS, including its upstream regulation during AF induction, remain inconclusive.…”