Sympathetic Nervous System Activation and Its Modulation: Role in Atrial Fibrillation

Abstract

The autonomic nervous system (ANS) has a significant influence on the structural integrity and electrical conductivity of the atria. Aberrant activation of the sympathetic nervous system can induce heterogeneous changes with arrhythmogenic potential which can result in atrial tachycardia, atrial tachyarrhythmias and atrial fibrillation (AF). Methods to modulate autonomic activity primarily through reduction of sympathetic outflow reduce the incidence of spontaneous or induced atrial arrhythmias in animal models and humans, suggestive of the potential application of such strategies in the management of AF. In this review we focus on the relationship between the ANS, sympathetic overdrive and the pathophysiology of AF, and the potential of sympathetic neuromodulation in the management of AF. We conclude that sympathetic activity plays an important role in the initiation and maintenance of AF, and modulating ANS function is an important therapeutic approach to improve the management of AF in selected categories of patients. Potential therapeutic applications include pharmacological inhibition with central and peripheral sympatholytic agents and various device based approaches. While the role of the sympathetic nervous system has long been recognized, new developments in science and technology in this field promise exciting prospects for the future.

Increased Overall Heart Rate Irregularity Risk by Hyperuricemia in the General Population: Results from the Korean National Health and Nutrition Examination Survey

“…Hypertension is a common cardiovascular risk factor, and hypertensive heart disease can manifest as several cardiac arrhythmias [ 37 , 38 ]. Hypertension can lead to left ventricular hypertrophy and myocardial fibrosis and can trigger arrhythmia by activating the sympathetic nervous system and the renin–angiotensin–aldosterone system [ 39 , 40 ]. Mechanical overload due to high blood pressure may induce an abnormal expression of ion channels and/or junctional complexes [ 41 ].…”

Radiofrequency catheter ablation of a sporadically occurring ventricular arrhythmia originating from the right ventricular outflow tract: A novel arrhythmia induction strategy involving atrial fibrillation provocation

“…Second, it has been reported that AF activates the autonomic nervous system in both animal model and human studies. 7 , 8 Furthermore, a recent study reported that arrhythmogenesis in the RVOT is associated with sympathetic fibers in the animal model. 1 Therefore, the increased sympathetic tone induced by AF would play an important role in the induction of RVOT arrhythmias.…”

Ganglionated Plexi Ablation Suppresses Chronic Obstructive Sleep Apnea-Related Atrial Fibrillation by Inhibiting Cardiac Autonomic Hyperactivation

“…The imbalanced state of the ANS has been gradually recognized in AF associated with OSA (Carnagarin et al, 2019;Huang et al, 2020). Treatment measures that modulate the ANS, including metoprolol (Li et al, 2015;Sun et al, 2017;Dai et al, 2019) and LLTS (Yu et al, 2017b), could inhibit the inducibility of AF.…”