Institute of Applied Health Research, University of Birmingham, Birmingham, UK.
Liverpool Centre for Cardiovascular Science, University of Liverpool, Liverpool, UK.
Eur J Clin Invest. 2019 Nov;49(11):e13174. doi: 10.1111/eci.13174.
Atrial fibrillation (AF) is the commonest abnormal heart rhythm with significant related morbidity and mortality. Several pathophysiologic mechanisms have been advocated to explain the onset of AF. There has been increasing evidence that abnormalities of the autonomic nervous system (ANS) that includes sympathetic, parasympathetic and intrinsic neural network are involved in the pathogenesis of AF. This review will consider the anatomical and pathophysiological concepts of the cardiac neuronal network and discuss how it can be investigated.
Relevant articles for this review were selected primarily from Ovid Medline and Embase databases (see appendix). We searched for key terms "atrial fibrillation," "AF," "autonomic dysfunction," "autonomic nervous system," "heart rate variability" and "HRV" to gather relevant studies. Duplicate papers were excluded.
Heart is richly innervated by autonomic nerves. Both sympathetic and parasympathetic systems interact in developing AF along with cardiac ganglionated plexi (GP). Thus autonomic dysfunction is present in AF. There are methods including selective ablation that reduce autonomic innervation and show to reduce the incidence of spontaneous or induced atrial arrhythmias. Heart rate variability (HRV) is a useful tool to assess sympathetic and parasympathetic influences on disease states. HRV can be improved following intervention and is thus a useful application in assessing autonomic dysfunction in patients with AF.
ANS plays a crucial role in the development, propagation and complexity of AF. Assessment of the autonomic involvement in the propagation of AF may help in explaining why certain patients with AF do not benefit from cardioversion or ablation.
心房颤动（AF）是最常见的异常心律，与显著的相关发病率和死亡率有关。已经提出了几种病理生理机制来解释 AF 的发生。越来越多的证据表明，自主神经系统（ANS）的异常，包括交感神经、副交感神经和内在神经网络，与 AF 的发病机制有关。这篇综述将考虑心脏神经元网络的解剖和病理生理概念，并讨论如何对其进行研究。
本综述的相关文章主要从 Ovid Medline 和 Embase 数据库中选择（见附录）。我们搜索了“心房颤动”、“AF”、“自主功能障碍”、“自主神经系统”、“心率变异性”和“HRV”等关键词，以收集相关研究。排除重复的论文。
心脏被自主神经丰富地支配。交感和副交感系统在 AF 的发展过程中相互作用，同时还有心脏神经节丛（GP）。因此，AF 存在自主神经功能障碍。有一些方法，包括选择性消融，可以减少自主神经支配，并显示减少自发性或诱发性心房心律失常的发生。心率变异性（HRV）是评估疾病状态下交感和副交感神经对疾病影响的有用工具。HRV 可以通过干预得到改善，因此在评估 AF 患者的自主神经功能障碍方面是一种有用的应用。
ANS 在 AF 的发生、传播和复杂性中起着至关重要的作用。评估自主神经在 AF 传播中的参与情况可能有助于解释为什么某些 AF 患者不能从心脏复律或消融中获益。
