Department of Internal Medicine, University of Illinois at Chicago/Advocate Christ Medical Center, 4440 West 95th Street, 131 NO, Oak Lawn, IL 60453, USA.
Nat Rev Cardiol. 2011 Sep 27;9(1):30-9. doi: 10.1038/nrcardio.2011.139.
The past 5 years have seen great advances in the knowledge of neural mechanisms of atrial arrhythmogenesis. Direct autonomic nerve recordings demonstrate that simultaneous sympathovagal discharges and intrinsic cardiac nerve activities are common triggers of paroxysmal atrial tachycardia and atrial fibrillation. While activity of the autonomous nervous system (ANS) is crucial in triggering paroxysmal atrial fibrillation, a high incidence of sympathovagal co-activation at baseline is associated with a high vulnerability to pacing-induced sustained atrial fibrillation, suggesting that ANS has a role in the development of persistent atrial fibrillation. Modulation of ANS activity may constitute an important therapeutic strategy for the management of atrial tachyarrhythmias. Specifically, continuous, low-level stimulation of the left cervical vagus nerve effectively suppresses atrial tachyarrhythmias by reducing the nerve activity of the stellate ganglion. Clinically, compared with pulmonary vein isolation alone, the addition of ablation of intrinsic cardiac ganglia may confer better outcomes for patients with paroxysmal atrial fibrillation. These findings suggest that further investigation of the neural mechanisms of atrial arrhythmias might lead to better management of patients with atrial arrhythmias. In this article, we review the role of the ANS in the induction and maintenance of atrial arrhythmias and the role of neural modulation as a treatment strategy for atrial arrhythmias.
过去的 5 年中，人们对心房心律失常发生的神经机制的认识取得了重大进展。直接自主神经记录表明，同时发生的交感神经和心脏自主神经活动是阵发性心房心动过速和心房颤动的常见触发因素。虽然自主神经系统 (ANS) 的活动在触发阵发性心房颤动中至关重要，但基线时交感神经和副交感神经的高发生率与对起搏诱导的持续性心房颤动的高易感性相关，这表明 ANS 在持续性心房颤动的发生发展中具有一定作用。调节 ANS 活动可能是管理心房性心动过速的重要治疗策略。具体而言，通过降低星状神经节的神经活动，对左侧颈迷走神经进行持续、低水平的刺激可有效抑制心房性心动过速。临床上，与单纯肺静脉隔离相比，消融心脏自主神经节可能为阵发性心房颤动患者带来更好的结果。这些发现表明，进一步研究心房性心律失常的神经机制可能会导致更好地管理心房性心律失常患者。在本文中，我们回顾了 ANS 在心房性心律失常的诱导和维持中的作用，以及神经调节作为心房性心律失常治疗策略的作用。
