From the Department of Medicine, Division of Cardiology, The Krannert Institute of Cardiology (P.-S.C., S.-F.L.) and Department of Neurology (L.S.C.), Indiana University School of Medicine, Indianapolis; Department of Pathology and Laboratory Medicine, University of California, Los Angeles (M.C.F.); Institute of Biomedical Engineering, National Chiao Tung University, Hsinchu, Taiwan (S.-F.L.); and Department of Medicine, Montreal Heart Institute and Université de Montréal, Montreal, Quebec, Canada (S.N.).
Circ Res. 2014 Apr 25;114(9):1500-15. doi: 10.1161/CIRCRESAHA.114.303772.
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.
自主神经系统激活可引起心房电生理显著且不同的变化，并引发房性心动过速和心房颤动（房颤）等房性心律失常。自主神经系统在房颤发生机制中的重要性也得到了人类中症状性房颤发作的昼夜节律变化的支持。已经证明减少自主神经支配或传出的方法可降低自发性或诱发性心房心律失常的发生率，这表明神经调节可能有助于控制房颤。在本综述中，我们重点关注自主神经系统与房颤病理生理学之间的关系，以及神经调节在这种心律失常管理中的潜在益处和局限性。我们的结论是，自主神经活动在房颤的发生和维持中起重要作用，调节自主神经功能可能有助于房颤的控制。潜在的治疗应用包括神经节丛消融、肾交感神经去神经支配、颈迷走神经刺激、压力反射刺激、皮肤刺激、新型药物方法和生物疗法。尽管自主神经系统的作用早已被认识，但新的科学和新技术为未来带来了令人兴奋的前景。
