Aritmologia in Campania

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Role of the Autonomic Nervous System in Atrial Fibrillation: Pathophysiology and Therapy

Peng-Sheng Chen, Lan S. Chen, Michael C. Fishbein, Shien-Fong Lin and Stanley Nattel

Abstract: Autonomic nervous system activation can induce significant and heterogeneous changes of atrial
electrophysiology and induce atrial tachyarrhythmias, including atrial tachycardia and atrial fibrillation (AF). The
importance of the autonomic nervous system in atrial arrhythmogenesis is also supported by circadian variation
in the incidence of symptomatic AF in humans. Methods that reduce autonomic innervation or outflow have been
shown to reduce the incidence of spontaneous or induced atrial arrhythmias, suggesting that neuromodulation may
be helpful in controlling AF. In this review, we focus on the relationship between the autonomic nervous system and
the pathophysiology of AF and the potential benefit and limitations of neuromodulation in the management of this
arrhythmia. We conclude that autonomic nerve activity plays an important role in the initiation and maintenance
of AF, and modulating autonomic nerve function may contribute to AF control. Potential therapeutic applications
include ganglionated plexus ablation, renal sympathetic denervation, cervical vagal nerve stimulation, baroreflex
stimulation, cutaneous stimulation, novel drug approaches, and biological therapies. Although the role of the
autonomic nervous system has long been recognized, new science and new technologies promise exciting prospects
for the future. (Circ Res. 2014;114:1500-1515.)

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