Modulation of the autonomic nervous system for preventing perioperative atrial fibrillation: a review of literature

Introduction: Autonomic control of the heart is exerted by the neurocardiac axis, which comprises reflexes at three levels of cardiac activity: central (higher structures of the forebrain, brainstem, and spinal cord), intrathoracic extracardiac (stellate and dorsal root ganglia), and intracardiac. Neuromodulation of the autonomic nervous system (ANS) (ganglion plexus ablation, epicardial drug infusion for temporary neurotoxicity, low-level vagus nerve stimulation, stellate ganglion blockade, baroreceptor stimulation, spinal cord stimulation, renal and pulmonary artery nerve fiber denervation) is a new therapeutic approach for managing heart rhythm disorders and cardiovascular pathologies. Atrial fibrillation (AF) occurs in up to 30% of patients after open cardiac surgery and is associated with increased morbidity and mortality in the long-term follow-up.