Chen Jay, Wasmund Stephen L, Hamdan Mohamed H
Department of Internal Medicine, Division of Cardiology, University of Texas Southwestern Medical Center, Dallas, Texas, USA.
Pacing Clin Electrophysiol. 2006 Apr;29(4):413-21. doi: 10.1111/j.1540-8159.2006.00362.x.
The purpose of this manuscript is to review the current literature regarding the role of the autonomic nervous system (ANS) in atrial fibrillation (AF). We will be reviewing its effect on initiation, maintenance, and termination of AF, with emphasis on the role of baroreflex gain (BRG) and autonomic reflexes in the maintenance of this arrhythmia. While it is generally accepted that the ANS plays an important role in AF, the extent of that role remains controversial. Much of the controversy could be explained by the time frame during which the autonomic measurements were made, the differences in patient population, and possibly the differential effect of the autonomic changes on the trigger versus the substrate. While vagal stimulation results in shortening of the atrial effective refractory period and increased dispersion of refractoriness, its effect on the "trigger" might be antiarrhythmic. During AF, cardiac filling pressure increases while arterial blood pressure decreases sending conflicting messages to the medulla. The acute effect is an increase in sympathetic activity to ensure adequate hemodynamic stability. On the other hand, the long-term effects might be impairment in the cardiopulmonary BRG and changes that accentuate the presence of AF. While radiofrequency ablation has provided us with a unique insight into the role of possible denervation in AF suppression, the exact mechanisms involved are far from being completely understood. Today, in an era where great technological advances have occurred, our need to understand the role of the ANS in AF is greater than ever.
本手稿的目的是回顾当前关于自主神经系统（ANS）在心房颤动（AF）中作用的文献。我们将回顾其对房颤起始、维持和终止的影响，重点关注压力反射增益（BRG）和自主反射在这种心律失常维持中的作用。虽然人们普遍认为自主神经系统在房颤中起重要作用，但其作用程度仍存在争议。大部分争议可以通过进行自主神经测量的时间框架、患者群体的差异以及自主神经变化对触发因素与基质的不同影响来解释。虽然迷走神经刺激会导致心房有效不应期缩短和不应期离散度增加，但其对“触发因素”的影响可能是抗心律失常的。在房颤期间，心脏充盈压升高而动脉血压降低，向延髓发送相互矛盾的信息。急性效应是交感神经活动增加以确保足够的血流动力学稳定性。另一方面，长期影响可能是心肺压力反射增益受损以及加剧房颤存在的变化。虽然射频消融让我们对去神经支配在房颤抑制中的作用有了独特的见解，但其中的确切机制远未完全明了。如今，在一个技术取得巨大进步的时代，我们比以往任何时候都更需要了解自主神经系统在房颤中的作用。
