title: Vagal atrial fibrillation: What is it and should we treat it?
abstract: Vagal atrial fibrillation (AF) remains an under-recognised entity, affecting younger patients often with structurally normal hearts. Although there remains no universal definition or diagnostic criteria, in this review we describe recognised triggers and associated features, including a well-established association with athletic training. We explore potential mechanisms, including the role of the autonomic nervous system and ganglionated plexi in initiating and maintaining arrhythmia. We discuss the limited evidence base addressing the question of progression to persistent AF, and debate the merits of anti-arrhythmic treatment, as well as uncertainty regarding the risk of stroke. Differences in suggested pharmacological therapy are highlighted and as is the emerging promise of radiofrequency catheter ablation as a therapeutic option. As we recognise the emerging burden of vagal AF, we hope to explore the important similarities and differences crucial to developing our understanding of the disorder, and highlight some significant questions which remain unanswered.
authors: Bristol Heart Institute, University Hospitals Bristol NHS Trust, United Kingdom. Electronic address: carpenter.alexander@gmail.com.
authors: Alexander
authors: A
authors: Carpenter
authors: Bristol Heart Institute, University Hospitals Bristol NHS Trust, United Kingdom.
authors: Antonio
authors: A
authors: Frontera
authors: Bristol Heart Institute, University Hospitals Bristol NHS Trust, United Kingdom.
authors: Richard
authors: R
authors: Bond
authors: Bristol Heart Institute, University Hospitals Bristol NHS Trust, United Kingdom.
authors: Edward
authors: E
authors: Duncan
authors: Bristol Heart Institute, University Hospitals Bristol NHS Trust, United Kingdom.
authors: Glyn
authors: G
authors: Thomas
mesh_terms: D000889:Anti-Arrhythmia Agents / Q000627:therapeutic use; D001281:Atrial Fibrillation / Q000175:diagnosis* / Q000628:therapy*; D017115:Catheter Ablation / Q000379:methods*; D006801:Humans; D012307:Risk Factors; D016896:Treatment Outcome; D014630:Vagus Nerve / Q000503:physiopathology*
chemical_list: D000889:Anti-Arrhythmia Agents
keywords: Atrial fibrillation in athletes; Autonomic nervous system; Paroxysmal atrial fibrillation; Vagal atrial fibrillation