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Review
. 2023 Jul;9(7 Pt 2):1196-1206.
doi: 10.1016/j.jacep.2023.02.019. Epub 2023 Apr 19.

Autonomic Nervous System and Cardiac Metabolism: Links Between Autonomic and Metabolic Remodeling in Atrial Fibrillation

Praloy Chakraborty  1 , Kassem Farhat  1 , Sunny S Po  1 , Antonis A Armoundas  2 , Stavros Stavrakis  3
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Free article
Review

Autonomic Nervous System and Cardiac Metabolism: Links Between Autonomic and Metabolic Remodeling in Atrial Fibrillation

Praloy Chakraborty et al. JACC Clin Electrophysiol. 2023 Jul.
Free article

Abstract

Simultaneous activation of the sympathetic and parasympathetic nervous systems is crucial for the initiation of paroxysmal atrial fibrillation (AF). However, unbalanced activation of the sympathetic system is characteristic of autonomic remodeling in long-standing persistent AF. Moreover, the adrenergic activation-induced metabolic derangements provide a milieu for acute AF and promote the transition from the paroxysmal to the persistent phase of AF. On the other hand, cholinergic activation ameliorates the maladaptive metabolic remodeling in the face of metabolic challenges. Selective inhibition of the sympathetic system and restoration of the balance of the cholinergic system by neuromodulation is emerging as a novel nonpharmacologic strategy for managing AF. This review explores the link between cardiac autonomic and metabolic remodeling and the potential roles of different autonomic modulation strategies on atrial metabolic aberrations in AF.

Keywords: atrial fibrillation; autonomic nervous system; metabolic remodeling.

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Conflict of interest statement

Funding Support and Author Disclosures This work was funded by National Institutes of Health/National Heart, Lung, and Blood Institute grant R01HL161008 to Dr Stavrakis. Dr Chakraborty is supported by the George Mine travel fellowship by the Canadian Heart Rhythm Society. Funding from the Institute of Precision Medicine (17UNPG33840017) of the American Heart Association, the RICBAC Foundation, and National Institutes of Health grants R01 HL135335-01, R21 HL137870-01, R21EB026164-01, and R21EB026164-02S1 was awarded to Dr Armoundas. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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