Neuroscientific therapies for atrial fibrillation

作     者：Hanna, Peter Buch, Eric Stavrakis, Stavros Meyer, Christian Tompkins, John D. Ardell, Jeffrey L. Shivkumar, Kalyanam 

作者机构：Univ Calif Los Angeles UCLA David Geffen Sch Med Cardiac Arrhythmia Ctr 100 Med PlazaSuite 660 Los Angeles CA 90095 USA UCLA David Geffen Sch Med Neurocardiol Res Program Excellence 100 Med PlazaSuite 660 Los Angeles CA 90095 USA UCLA David Geffen Sch Med Mol Cellular & Integrat Physiol Program 100 Med PlazaSuite 660 Los Angeles CA 90095 USA Univ Oklahoma Heart Rhythm Inst Hlth Sci Ctr 1100 N Lindsay Ave Oklahoma City OK 73104 USA Teaching Hosp Univ Dusseldorf Div Cardiol Cardiac Neuro & Electrophysiol Res Consortium cNE EVK Dusseldorf Kirchfeldstr 40 D-40217 Dusseldorf Germany Univ Dusseldorf Inst Neural & Sensory Physiol Cardiac Neuro & Electrophysiol Res Consortium cNE Univ Str 1 D-40225 Dusseldorf Germany 

出 版 物：《CARDIOVASCULAR RESEARCH》 (心血管研究)

年 卷 期：2021年第117卷第7期

页      面：1732-1745页

核心收录：

学科分类：1002[医学-临床医学] 100201[医学-内科学(含：心血管病、血液病、呼吸系病、消化系病、内分泌与代谢病、肾病、风湿病、传染病)] 10[医学] 

基　　金：NIH through the Common Fund's Stimulating Peripheral Activity to Relieve Conditions (SPARC) programme [OT2 OD023848] National Heart, Lung, and Blood Institute Ruth L. Kirschstein Postdoctoral Individual National Research Service [F32 HL152609] National Heart Lung and Blood Institute [F32HL152609] Funding Source: NIH RePORTER 

主　　题：Atrial fibrillation Autonomic nervous system Neurocardiology Neuromodulation Vagus nerve 

摘      要：The cardiac autonomic nervous system (ANS) plays an integral role in normal cardiac physiology as well as in disease states that cause cardiac arrhythmias. The cardiac ANS, comprised of a complex neural hierarchy in a nested series of interacting feedback loops, regulates atrial electrophysiology and is itself susceptible to remodelling by atrial rhythm. In light of the challenges of treating atrial fibrillation (AF) with conventional pharmacologic and myoablative techniques, increasingly interest has begun to focus on targeting the cardiac neuraxis for AF. Strong evidence from animal models and clinical patients demonstrates that parasympathetic and sympathetic activity within this neuraxis may trigger AF, and the ANS may either induce atrial remodelling or undergo remodelling itself to serve as a substrate for AF. Multiple nexus points within the cardiac neuraxis are therapeutic targets, and neuroablative and neuromodulatory therapies for AF include ganglionated plexus ablation, epicardial botulinum toxin injection, vagal nerve (tragus) stimulation, renal denervation, stellate ganglion block/resection, baroreceptor activation therapy, and spinal cord stimulation. Pre-clinical and clinical studies on these modalities have had promising results and are reviewed here.