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Review
. 2012 Aug 1;5(4):850-9.
doi: 10.1161/CIRCEP.112.972273.

Recent insights into the role of the autonomic nervous system in the creation of substrate for atrial fibrillation: implications for therapies targeting the atrial autonomic nervous system

Rishi Arora  1
Affiliations
Review

Recent insights into the role of the autonomic nervous system in the creation of substrate for atrial fibrillation: implications for therapies targeting the atrial autonomic nervous system

Rishi Arora. Circ Arrhythm Electrophysiol. .
No abstract available

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Conflict of interest statement

Conflict of Interest Disclosures: He is has ownership interest in Rhythm Solutions, LLC as founder and Rythmos Therapeutics as co-founder.

Figures

Figure 1
Figure 1
Comparison of nerve density and distribution in HF vs normal atria. Panel A: Examples of sympathetic and parasympathetic nerve staining in HF atria. Sympathetic fibers were stained by dopamine beta-hydroxylase, while parasympathetic fibers were stained by acetylcholine esterase. A.i. – example of a nerve bundle located in the fibrofatty tissue overlying the epicardium (EPI) (10X). ENDO – endocardium. A.ii. – example of nerve bundles located in fibrofatty tissue on the epicardial aspect of PV (4X). Sympathetic fibers are in blue (arrows). A.iii. – examples of cardiac ganglia, with parasympathetic fibers arising from cardiac ganglion on the left side (20X). A.iv. - example of cardiac ganglia on the left and nerve bundle on the right; nerve fibers showing co-localized sympathetic (blue) and parasympathetic fibers (brown) (20X). Panel B: Quantitative analysis of nerve staining in HF vs normal atria. B.i. – nerve bundle density, B.ii. – nerve bundle size, B.iii. – number of parasympathetic nerve fibers/bundle, B.iv. – number of sympathetic nerve fibers/bundle, B.v. – density of cardiac ganglia, B.vi. – number of cell bodies/cardiac ganglion, B.vii. - density of sympathetic fibers, B.viii. – density of parasympathetic fibers.(modified from Ng et al, Autonomic Remodeling in the Posterior Left Atrium and Pulmonary Veins in Heart Failure – Creation of a Dynamic Substrate for Atrial Fibrillation. Circulation-Arrhythmia and Electrophysiology 2011;4(3):388–96).
Figure 2
Figure 2
Proposed model of creation of autonomic substrate for AF in CHF. The model suggests the likely presence of synergistic interactions between structural changes (fibrosis) and autonomic remodeling in the creation of AF substrate in heart failure. ACh = acetylcholine, AChE = acetylcholinesterase, β1AR – beta-1 adrenergic receptor, ERP = effective refractory period (modified from Ng et al, Autonomic Remodeling in the Posterior Left Atrium and Pulmonary Veins in Heart Failure – Creation of a Dynamic Substrate for Atrial Fibrillation. Circulation-Arrhythmia and Electrophysiology 2011;4(3):388–96).
Figure 3
Figure 3
The figure shows the signaling cascade for sympathetic and parasympathetic signaling. The large arrow with the asterix (*) below is pointing at the M2/Gαi/o interface, to which the Gα-C-terminal peptides (see text) are directed.
See this image and copyright information in PMC

References

    1. Ng J, Villuendas R, Cokic I, Schliamser JE, Gordon D, Koduri H, Benefield B, Simon J, Murthy SN, Lomasney JW, Wasserstrom JA, Goldberger JJ, Aistrup GL, Arora R. Autonomic remodeling in the left atrium and pulmonary veins in heart failure: Creation of a dynamic substrate for atrial fibrillation. Circ Arrhythm Electrophysiol. 2011;4:388–396. - PMC - PubMed
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    1. Patterson E, Po SS, Scherlag BJ, Lazzara R. Triggered firing in pulmonary veins initiated by in vitro autonomic nerve stimulation.[see comment] Heart Rhythm. 2005;2:624–631. - PubMed

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