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Central Sympathetic Inhibition: a Neglected Approach for Treatment of Cardiac Arrhythmias?

  • Device-Based Approaches for Hypertension (M Schlaich, Section Editor)
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Abstract

Atrial fibrillation (AF) is the most common sustained cardiac arrhythmia. Overactivation of the sympathetic nervous system (SNS) plays an important role in the pathogenesis of comorbidities related to AF such as hypertension, congestive heart failure, obesity, insulin resistance, and obstructive sleep apnea. Methods that reduce sympathetic drive, such as centrally acting sympatho-inhibitory agents, have been shown to reduce the incidence of spontaneous or induced atrial arrhythmias, suggesting that neuromodulation may be helpful in controlling AF. Moxonidine acts centrally to reduce activity of the SNS, and clinical trials indicate that this is associated with a decreased AF burden in hypertensive patients with paroxysmal AF and reduced post-ablation recurrence of AF in patients with hypertension who underwent pulmonary vein isolation (PVI). Furthermore, device-based approaches to reduce sympathetic drive, such as renal denervation, have yielded promising results in the prevention and treatment of cardiac arrhythmias. In light of these recent findings, targeting elevated sympathetic drive with either pharmacological or device-based approaches has become a focus of clinical research. Here, we review the data currently available to explore the potential utility of sympatho-inhibitory therapies in the prevention and treatment of cardiac arrhythmias.

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Authors and Affiliations

  1. Department of Medical Science, Internal Medicine Ward and Hypertension Centre Azienda Ospedaliera, Treviglio, BG, Italy

    Francesca Cagnoni, Maurizio Destro, Erika Bontempelli & Giovanni Locatelli

  2. Dobney Hypertension Centre School of Medicine and Pharmacology - Royal Perth Hospital Unit, University of Western Australia, Level 3, MRF Building, Rear 50 Murray St, Perth, WA, 6000, Australia

    Francesca Cagnoni, Dagmara Hering & Markus P. Schlaich

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  1. Francesca Cagnoni
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  2. Maurizio Destro
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Correspondence to Markus P. Schlaich.

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Conflict of Interest

Dr. Schlaich is supported by career fellowships from the NHMRC, is an investigator in studies sponsored by Medtronic, serves on scientific advisory boards for Abbott (formerly Solvay) Pharmaceuticals, BI, Novartis Pharmaceuticals, and Medtronic and has received honoraria and travel support from Abbott, BI, Servier, Novartis, and Medtronic. Drs. Cagnoni, Destro, Bontempelli, Locatelli, and Hering declare no conflicts of interest.

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This article is part of the Topical Collection on Device-Based Approaches for Hypertension

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Cagnoni, F., Destro, M., Bontempelli, E. et al. Central Sympathetic Inhibition: a Neglected Approach for Treatment of Cardiac Arrhythmias?. Curr Hypertens Rep 18, 13 (2016). https://doi.org/10.1007/s11906-015-0619-0

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