With
the advent of catheter ablation of atrial fibrillation (AF) there has been
acceleration in our understanding of the mechanisms underlying the etiology of
this common clinical arrhythmia. In this regard, the role of the intrinsic
cardiac autonomic nervous system in the initiation and maintenance of AF began
to receive attention in numerous experimental and clinical investigations. Up
to now, the focus has been on the large ganglionated plexi (GP) which are
located in the posterior left atrium mainly at the pulmonary vein-atrial
junctions. As long term outcomes have been reported and single procedures have
indicated diminished success rates particularly for persistent/long standing
persistent AF, emphasis has begun to shift away from the pulmonary vein
isolation (PVI) alone as well as GP ablation with or without PVI. An
understanding of the atrial substrate represented by the extensions of the
intrinsic cardiac autonomic system constituting the atrial neural network is
beginning to evolve. In this review, the contribution of the intrinsic cardiac
autonomic nervous system to the etiology of AF is addressed, particularly in
regard to the greater prevalence of AF in the elderly. In addition, we
emphasize the involvement of the atrial neural network in the pathological
progression of paroxysmal to persistent and long standing persistent forms of
AF.
Credits: Shen X; Scherlag BJ; He B; Sun J; Mei G; Po SS