Neuromodulation for Atrial Fibrillation Control

Overview

Journal Korean Circ J

Date 2024 Apr 24

PMID 38654454

Authors

Seil Oh

Affiliations

Soon will be listed here.

Abstract

Trigger and functional substrate are related to the tone of autonomic nervous system, and the role of the autonomic nerve is more significant in paroxysmal atrial fibrillation (AF) compared to non-paroxysmal AF. We have several options for neuromodulation to help to manage patients with AF. Neuromodulation targets can be divided into efferent and afferent pathways. On the efferent side, block would be an intuitive approach. However, permanent block is hard to achieve due to completeness of the procedure and reinnervation issues. Temporary block such as botulinum toxin injection into ganglionated plexi would be a possible option for post-cardiac surgery AF. Low-level subthreshold stimulation could also prevent AF, but the invasiveness of the procedure is the barrier for the general use. On the afferent side, block is also an option. Various renal denervation approaches are currently under investigation. Auditory vagus nerve stimulation is one of the representative low-level afferent stimulation methods. This technique is noninvasive and easy to apply, so it has the potential to be widely utilized if its efficacy is confirmed.

References

Stavrakis S, Humphrey M, Scherlag B, Iftikhar O, Parwani P, Abbas M . Low-Level Vagus Nerve Stimulation Suppresses Post-Operative Atrial Fibrillation and Inflammation: A Randomized Study. JACC Clin Electrophysiol. 2018; 3(9):929-938. DOI: 10.1016/j.jacep.2017.02.019. View

De Marco T, Dae M, Kumar S, Sudhir K, KEITH F, Amidon T . Iodine-123 metaiodobenzylguanidine scintigraphic assessment of the transplanted human heart: evidence for late reinnervation. J Am Coll Cardiol. 1995; 25(4):927-31. DOI: 10.1016/0735-1097(94)00463-z. View

Waldron N, Cooter M, Haney J, Schroder J, Gaca J, Lin S . Temporary autonomic modulation with botulinum toxin type A to reduce atrial fibrillation after cardiac surgery. Heart Rhythm. 2018; 16(2):178-184. DOI: 10.1016/j.hrthm.2018.08.021. View

Wu C, Russell R, Karten H . The transport rate of cholera toxin B subunit in the retinofugal pathways of the chick. Neuroscience. 1999; 92(2):665-76. DOI: 10.1016/s0306-4522(99)00018-4. View

Kaseda S, Zipes D . Supersensitivity to acetylcholine of canine sinus and AV nodes after parasympathetic denervation. Am J Physiol. 1988; 255(3 Pt 2):H534-9. DOI: 10.1152/ajpheart.1988.255.3.H534. View

Pokushalov E, Kozlov B, Romanov A, Strelnikov A, Bayramova S, Sergeevichev D . Long-Term Suppression of Atrial Fibrillation by Botulinum Toxin Injection Into Epicardial Fat Pads in Patients Undergoing Cardiac Surgery: One-Year Follow-Up of a Randomized Pilot Study. Circ Arrhythm Electrophysiol. 2015; 8(6):1334-41. DOI: 10.1161/CIRCEP.115.003199. View

Oh S, Choi E, Zhang Y, Mazgalev T . Botulinum toxin injection in epicardial autonomic ganglia temporarily suppresses vagally mediated atrial fibrillation. Circ Arrhythm Electrophysiol. 2011; 4(4):560-5. DOI: 10.1161/CIRCEP.111.961854. View

Stavrakis S, Humphrey M, Scherlag B, Hu Y, Jackman W, Nakagawa H . Low-level transcutaneous electrical vagus nerve stimulation suppresses atrial fibrillation. J Am Coll Cardiol. 2015; 65(9):867-75. PMC: 4352201. DOI: 10.1016/j.jacc.2014.12.026. View

Stavrakis S, Stoner J, Humphrey M, Morris L, Filiberti A, Reynolds J . TREAT AF (Transcutaneous Electrical Vagus Nerve Stimulation to Suppress Atrial Fibrillation): A Randomized Clinical Trial. JACC Clin Electrophysiol. 2020; 6(3):282-291. PMC: 7100921. DOI: 10.1016/j.jacep.2019.11.008. View

10.

Schwaiger M, Hutchins G, Kalff V, Rosenspire K, Haka M, Mallette S . Evidence for regional catecholamine uptake and storage sites in the transplanted human heart by positron emission tomography. J Clin Invest. 1991; 87(5):1681-90. PMC: 295266. DOI: 10.1172/JCI115185. View

11.

Cummings J, Gill I, Akhrass R, Dery M, Biblo L, Quan K . Preservation of the anterior fat pad paradoxically decreases the incidence of postoperative atrial fibrillation in humans. J Am Coll Cardiol. 2004; 43(6):994-1000. DOI: 10.1016/j.jacc.2003.07.055. View

12.

Zepeda-Echavarria A, van de Leur R, van Sleuwen M, Hassink R, Wildbergh T, Doevendans P . Electrocardiogram Devices for Home Use: Technological and Clinical Scoping Review. JMIR Cardio. 2023; 7:e44003. PMC: 10362423. DOI: 10.2196/44003. View

13.

Melo J, Voigt P, Sonmez B, Ferreira M, Abecasis M, Rebocho M . Ventral cardiac denervation reduces the incidence of atrial fibrillation after coronary artery bypass grafting. J Thorac Cardiovasc Surg. 2004; 127(2):511-6. DOI: 10.1016/s0022-5223(03)01283-2. View

14.

Alex J, Guvendik L . Evaluation of ventral cardiac denervation as a prophylaxis against atrial fibrillation after coronary artery bypass grafting. Ann Thorac Surg. 2005; 79(2):517-20. DOI: 10.1016/j.athoracsur.2004.08.011. View

15.

Bettoni M, Zimmermann M . Autonomic tone variations before the onset of paroxysmal atrial fibrillation. Circulation. 2002; 105(23):2753-9. DOI: 10.1161/01.cir.0000018443.44005.d8. View

16.

Kwon S, Lee E, Ju H, Ahn H, Lee S, Choi E . Machine Learning Prediction for the Recurrence After Electrical Cardioversion of Patients With Persistent Atrial Fibrillation. Korean Circ J. 2023; 53(10):677-689. PMC: 10625851. DOI: 10.4070/kcj.2023.0012. View

17.

Khan M, Kalahasti V, Rajagopal V, Khaykin Y, Wazni O, Almahameed S . Incidence of atrial fibrillation in heart transplant patients: long-term follow-up. J Cardiovasc Electrophysiol. 2006; 17(8):827-31. DOI: 10.1111/j.1540-8167.2006.00497.x. View

18.

Lee S, Cho Y, Cha M, Choi E, Seo J, Oh S . Atrial Innervation Patterns of Intrinsic Cardiac Autonomic Nerves. J Korean Med Sci. 2018; 33(39):e253. PMC: 6146147. DOI: 10.3346/jkms.2018.33.e253. View

19.

Yu L, Scherlag B, Sha Y, Li S, Sharma T, Nakagawa H . Interactions between atrial electrical remodeling and autonomic remodeling: how to break the vicious cycle. Heart Rhythm. 2012; 9(5):804-9. DOI: 10.1016/j.hrthm.2011.12.023. View

20.

Steinberg J, Shabanov V, Ponomarev D, Losik D, Ivanickiy E, Kropotkin E . Effect of Renal Denervation and Catheter Ablation vs Catheter Ablation Alone on Atrial Fibrillation Recurrence Among Patients With Paroxysmal Atrial Fibrillation and Hypertension: The ERADICATE-AF Randomized Clinical Trial. JAMA. 2020; 323(3):248-255. PMC: 6990678. DOI: 10.1001/jama.2019.21187. View