title: Atrial autonomic innervation: a target for interventional antiarrhythmic therapy?
abstract: Atrial fibrillation is the most common arrhythmia and is associated with significant morbidity and mortality. The autonomic nervous system contributes to the creation of atrial fibrillation substrates. Atrial electrophysiology is influenced differently by sympathetic and parasympathetic activation. Several strategies are available to modulate the complex interaction between the autonomic nervous system and the heart. However, different approaches target the problem differently making the prediction of arrhythmogenic and/or antiarrhythmic effects difficult. We discuss the role of the autonomic nervous system on the development of a substrate for atrial fibrillation and explore the potential antiarrhythmic and/or arrhythmogenic effect of modulation of the autonomic nervous system by renal sympathetic denervation, ganglionated plexi ablation, ganglion stellatum ablation, high thoracic epidural anesthesia, low-level vagal nerve stimulation, and baroreflex stimulation.
authors.affiliation: Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg, Saarland, Germany. Electronic address: Dominik.linz@uks.eu.
authors.forename: Dominik
authors.initials: D
authors.lastname: Linz
authors.affiliation: Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg, Saarland, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Ukena
authors.affiliation: Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg, Saarland, Germany.
authors.forename: Felix
authors.initials: F
authors.lastname: Mahfoud
authors.affiliation: Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg, Saarland, Germany.
authors.forename: Hans-Ruprecht
authors.initials: HR
authors.lastname: Neuberger
authors.affiliation: Kardiologie, Angiologie und Internistische Intensivmedizin, Universitätsklinikum des Saarlandes, Homburg, Saarland, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Böhm
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use*; D001341:Autonomic Nervous System / Q000187:drug effects / Q000503:physiopathology / Q000601:surgery; D017115:Catheter Ablation / Q000379:methods*; D004562:Electrocardiography; D006325:Heart Atria / Q000294:innervation*; D006801:Humans; D013562:Sympathectomy / Q000379:methods*
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: AERP; AF; BRS; CB; GP; M2R; OSA; PVI; RDN; atrial effective refractory period; atrial fibrillation; autonomic modulation; baroreceptor stimulation; baroreflex stimulation; carotid bodies; cholinergic muscarinergic receptors; ganglionated plexi; obstructive sleep apnea; pulmonary vein isolation; renal denervation; renal sympathetic denervation