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Rattanawong P, Kewcharoen J, S Srivathsan K, et al. Drug Therapy for Vagally-Mediated Atrial Fibrillation and Sympatho-Vagal Balance in the Genesis of Atrial Fibrillation: A Review of the Current Literature. J Atr Fibrillation. 2020;13(1):2410doi: 10.4022/jafib.2410.
Rattanawong, P., Kewcharoen, J., S Srivathsan, K., & Shen, W. K. (2020). Drug Therapy for Vagally-Mediated Atrial Fibrillation and Sympatho-Vagal Balance in the Genesis of Atrial Fibrillation: A Review of the Current Literature. Journal of atrial fibrillation, 13(1), 2410. https://doi.org/10.4022/jafib.2410
Rattanawong, Pattara, et al. "Drug Therapy for Vagally-Mediated Atrial Fibrillation and Sympatho-Vagal Balance in the Genesis of Atrial Fibrillation: A Review of the Current Literature." Journal of atrial fibrillation vol. 13,1 (2020): 2410. doi: https://doi.org/10.4022/jafib.2410
Rattanawong P, Kewcharoen J, S Srivathsan K, Shen WK. Drug Therapy for Vagally-Mediated Atrial Fibrillation and Sympatho-Vagal Balance in the Genesis of Atrial Fibrillation: A Review of the Current Literature. J Atr Fibrillation. 2020 Jun 30;13(1):2410. doi: 10.4022/jafib.2410. eCollection 2020. PMID: 33024510; PMCID: PMC7533140.
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J Atr Fibrillation. 2020 Jun 30;13(1):2410. doi: 10.4022/jafib.2410. eCollection 2020.

Drug Therapy for Vagally-Mediated Atrial Fibrillation and Sympatho-Vagal Balance in the Genesis of Atrial Fibrillation: A Review of the Current Literature.

Journal of atrial fibrillation

Pattara Rattanawong, Jakrin Kewcharoen, Komandoor S Srivathsan, Win-Kuang Shen

Affiliations

  1. Department of Cardiovascular Medicine, Mayo Clinic, Phoenix, AZ, USA.
  2. University of Hawaii Internal Medicine Residency Program, Honolulu, HI, USA.

PMID: 33024510 PMCID: PMC7533140 DOI: 10.4022/jafib.2410

Abstract

OBJECTIVE: The presence of both sympathetic activation-mediated triggers and parasympathetic activation-mediated substrates are required to initiate and maintain some forms of atrial fibrillation (AF). AF predominantly precipitated by parasympathetic stimulation is known as vagally-mediated AF (VM-AF). The role of novel drugs and molecular targeted gene therapy that modulate the autonomic nervous system are therapeutic options in this unique population with VM-AF. Here, we review the role of the sympatho-vagal balance in the genesis of AF and consider drug therapy for VM-AF.

METHODS: In accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Statement, literature search was conducted using the keywords "vagal", "vagal nerve", "vagus", "vagus nerve", and "atrial fibrillation". Retrieved citations were first screened independently by 2 reviewers for inclusion and exclusion criteria.

RESULTS: A total of 14 studies and 3 practice guidelines from 1986-2017 were included. Only two clinical investigations evaluated the effectiveness of disopyramide and sotalol in human subjects with VM-AF. The potential role of antiarrhythmic drugs has been studied in animal models.

CONCLUSIONS: Growing evidence suggests that the autonomic nervous system is integral in the development of VM-AF. Novel medications and genetic targets are undergoing investigation with promising results.

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