Autonomic dysregulation and atrial arrhythmias

The autonomic nervous system (ANS) and its dysregulation are recognized as important mechanisms underlying atrial arrhythmias, such as atrial fibrillation (AF). In this review, we describe the anatomy of the cardiac nervous system, sympathetic and parasympathetic effects on atrial electrophysiology, and how dysregulation of those may predispose to AF initiation and promote its maintenance. We then discuss how the ANS itself undergoes functional and structural remodeling in the setting of atrial arrhythmias, and what are the current neuromodulation approaches for AF prevention and treatment. These strategies include destruction of cardiac ANS structures or modification of autonomic signaling using nerve stimulation, pharmacological or gene therapy. Autonomic mechanisms of AF have been a focus of basic and translational research for many years, and now with the development of new diagnostic tools and therapeutic methods, ANS-targeted approaches have a potential to become an important part of AF treatment.