Heart rate variability in atrial fibrillation: The balance between sympathetic and parasympathetic nervous system
Open accessAbstract
Background: Atrial fibrillation (AF) is the commonest abnormal heart rhythm with significant related morbidity and mortality. Several pathophysiologic mechanisms have been advocated to explain the onset of AF. There has been increasing evidence that abnormalities of the autonomic nervous system (ANS) that includes sympathetic, parasympathetic and intrinsic neural network are involved in the pathogenesis of AF. This review will consider the anatomical and pathophysiological concepts of the cardiac neuronal network and discuss how it can be investigated. Design: Relevant articles for this review were selected primarily from Ovid Medline and Embase databases (see appendix). We searched for key terms “atrial fibrillation,” “AF,” “autonomic dysfunction,” “autonomic nervous system,” “heart rate variability” and “HRV” to gather relevant studies. Duplicate papers were excluded. Results: Heart is richly innervated by autonomic nerves. Both sympathetic and parasympathetic systems interact in developing AF along with cardiac ganglionated plexi (GP). Thus autonomic dysfunction is present in AF. There are methods including selective ablation that reduce autonomic innervation and show to reduce the incidence of spontaneous or induced atrial arrhythmias. Heart rate variability (HRV) is a useful tool to assess sympathetic and parasympathetic influences on disease states. HRV can be improved following intervention and is thus a useful application in assessing autonomic dysfunction in patients with AF. Conclusion: ANS plays a crucial role in the development, propagation and complexity of AF. Assessment of the autonomic involvement in the propagation of AF may help in explaining why certain patients with AF do not benefit from cardioversion or ablation.
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Elevated sympathetic tone contributes to the development of both atrial and ventricular arrhythmias.
“Elevated sympathetic tone contributes to the development of both atrial and ventricular arrythmias155–158, suggesting a potential benefit of RDN.”
From Renal nerves in physiology, pathophysiology and interoception (2025) · cites this paper as [155]
The ‘Autonomic dysfunction in atrial fibrillation’ section says sympathetic activity promotes arrhythmia and describes sympathetically mediated atrial fibrillation. It does not say that elevated sympathetic tone contributes to the development of ventricular arrhythmias; the ventricular mentions found concern ventricular response or dimensions, not ventricular arrhythmias. No page numbers are available in our copy. (LLM, conf=0.88)
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- Authors
- Khan, A. A., Lip, G. Y. H., & Shantsila, A.
- Affiliations
- University of Birmingham (GB)
- University of Liverpool (GB)
- Corresponding author
- Shantsila, Alena
- Venue
- European Journal of Clinical Investigation
- Publisher
- Wiley
- Published
- 2019-10-29
- Volume
- 49
- Issue
- 11
- Pages
- e13174-e13174
- ISSN
- 0014-2972 (ISSN-L)
- 1365-2362
- OpenAlex
- W2975157746
- Cited by
- 172
- References
- 78
- Citations by year
- 2026: 13 · 2025: 30 · 2024: 34 · 2023: 41 · 2022: 28 · 2021: 22 · 2020: 4
- FWCI
- 2.44
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- European Journal of Clinical Investigation (publishedVersion)
- PubMed (publishedVersion)
- VBN Forskningsportal (Aalborg Universitet) (submittedVersion, other-oa)
- Funders
- National Institute for Health and Care Research (NF-SI-0616-10010)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Heart Rate Variability and Autonomic Control
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac electrophysiology and arrhythmias
- Keywords
- atrial fibrillation, heart rate variability, autonomic nervous system, sympathetic nervous system, parasympathetic nervous system, autonomic dysfunction, catheter ablation, cardioversion
- MeSH terms
- Atrial Fibrillation, Heart, Heart Rate, Humans, Parasympathetic Nervous System, Sympathetic Nervous System
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