Role of the Autonomic Nervous System in Atrial Fibrillation

Since the late 1990s, we have been intensely studying the role of the autonomic nervous system in the genesis and maintenance of atrial fibrillation (AF) and neurocardiogenic syncope.

AF can occur both in normal hearts and in those with significant structural changes. Episodes of AF in young individuals with apparently normal heart have always caught our attention. The fact that these patients often have dysautonomic-like manifestations led us to think that purposeful denervation could be a way to treat these cases, and this technique was pioneered in 2004. The effect of innervation seems to be not only due to neural stimulation but also by promoting disarray in the atrial syncytial architecture, in the sites of penetration of neurons, which detach the myocardial cells, disconnecting them. This disarrangement also promotes changes that can be detected in the endocardium by the local electrical signal, which we call AF Nests (AFN), and in the case of innervation, we call AFN type I.

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