Role of autonomic nervous system in atrial fibrillation

Dominik Linz, Adrian D. Elliott, Mathias Hohl, Varun Malik, Ulrich Schotten, Dobromir Dobrev, Stanley Nattel, Michael Böhm, John Floras, Dennis H. Lau, Prash Sanders

Research output: Contribution to journalReview articlepeer-review

65 Citations (Scopus)


Atrial fibrillation is the most common sustained arrhythmia and is associated with significant morbidity and mortality. The autonomic nervous system has a significant role in the milieu predisposing to the triggers, perpetuators and substrate for atrial fibrillation. It has direct electrophysiological effects and causes alterations in atrial structure. In a significant portion of patients with atrial fibrillation, the autonomic nervous system activity is likely a composite of reflex excitation due to atrial fibrillation itself and contribution of concomitant risk factors such as hypertension, obesity and sleep-disordered breathing. We review the role of autonomic nervous system activation, with focus on changes in reflex control during atrial fibrillation and the role of combined sympatho-vagal activation for atrial fibrillation initiation, maintenance and progression. Finally, we discuss the potential impact of combined aggressive risk factor management as a strategy to modify the autonomic nervous system in patients with atrial fibrillation and to reverse the arrhythmogenic substrate.

Original languageEnglish
Pages (from-to)181-188
Number of pages8
JournalInternational Journal of Cardiology
Publication statusPublished or Issued - 15 Jul 2019


  • Atrial fibrillation
  • Autonomic nervous system
  • Hypertension
  • Renal denervation
  • Risk factors
  • Sleep apnea

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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