Abstract
Objective: The presence of both sympathetic activation-mediated triggers and parasympathetic activation-mediated substrates are required to initiate and maintain some forms of atrial fibrillation (AF). AF predominantly precipitated by parasympathetic stimulation is known as vagally-mediated AF (VM-AF). The role of novel drugs and molecular targeted gene therapy that modulate the autonomic nervous system are therapeutic options in this unique population with VM-AF. Here, we review the role of the sympatho-vagal balance in the genesis of AF and consider drug therapy for VM-AF. Methods: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement, literature search was conducted using the keywords “vagal”, “vagal nerve”, “vagus”, “vagus nerve”, and “atrial fibrillation”. Retrieved citations were first screened independently by 2 reviewers for inclusion and exclusion criteria. Results: A total of 14 studies and 3 practice guidelines from 1986-2017 were included. Only two clinical investigations evaluated the effectiveness of disopyramide and sotalol in human subjects with VM-AF. The potential role of antiarrhythmic drugs has been studied in animal models. Conclusion: Growing evidence suggests that the autonomic nervous system is integral in the development of VM-AF. Novel medications and genetic targets are undergoing investigation with promising results.
Original language | English (US) |
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Pages (from-to) | 3-11 |
Number of pages | 9 |
Journal | Journal of Atrial Fibrillation |
Volume | 13 |
Issue number | 1 |
DOIs | |
State | Published - Jul 2020 |
Keywords
- Atrioventricular Block
- Cardioneuroablation
- Catheter Ablation
- Ganglionated Plexus
- Sinus Dysfunction
- Vasovagal Syncope
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine