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The Autonomic Coumel Triangle: A New Way to Define the Fascinating Relationship between Atrial Fibrillation and the Autonomic Nervous System

Authors :
Marco Rebecchi
Francesca Fanisio
Fabio Rizzi
Alessandro Politano
Ermenegildo De Ruvo
Cinzia Crescenzi
Germana Panattoni
Marianna Squeglia
Annamaria Martino
Stefano Sasso
Paolo Golia
Giulia Pugliese
Sofia Del Gigante
Domenico Giamundo
Pietro Desimone
Domenico Grieco
Lucia De Luca
Ignazio Giordano
Francesco Barillà
Marco Alfonso Perrone
Leonardo Calò
Ferdinando Iellamo
Source :
Life, Vol 13, Iss 5, p 1139 (2023)
Publication Year :
2023
Publisher :
MDPI AG, 2023.

Abstract

Arrhythmogenic substrate, modulating factors, and triggering factors (the so-called Coumel’s triangle concept) play a primary role in atrial fibrillation (AF) pathophysiology. Several years have elapsed since Coumel and co-workers advanced the concept of the relevance of autonomic nervous system (ANS) influences on atrial cells’ electrophysiological characteristics. The ANS is not only associated with cardiac rhythm regulation but also exerts an important role in the triggering and maintenance of atrial fibrillation. This review aims to describe in detail the autonomic mechanisms involved in the pathophysiology of atrial fibrillation (AF), starting from the hypothesis of an “Autonomic Coumel Triangle” that stems from the condition of the fundamental role played by the ANS in all phases of the pathophysiology of AF. In this article, we provide updated information on the biomolecular mechanisms of the ANS role in Coumel’s triangle, with the molecular pathways of cardiac autonomic neurotransmission, both adrenergic and cholinergic, and the interplay between the ANS and cardiomyocytes’ action potential. The heterogeneity of the clinical spectrum of the ANS and AF, with the ANS playing a relevant role in situations that may promote the initiation and maintenance of AF, is highlighted. We also report on drug, biological, and gene therapy as well as interventional therapy. On the basis of the evidence reviewed, we propose that one should speak of an “Autonomic Coumel’s Triangle” instead of simply “Coumel’s Triangle”.

Details

Language :
English
ISSN :
20751729
Volume :
13
Issue :
5
Database :
Directory of Open Access Journals
Journal :
Life
Publication Type :
Academic Journal
Accession number :
edsdoj.165823b705b142b5ae827c560fb37bee
Document Type :
article
Full Text :
https://doi.org/10.3390/life13051139