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Neuromodulation for the Management of Atrial Fibrillation—How to Optimize Patient Selection and the Procedural Approach

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Abstract

Purpose of Review

Neuromodulation for the management of atrial fibrillation (AF) has been a topic of increased interest in recent years; however, there are still challenges regarding which patients would benefit most from these treatments and how we can optimize neuromodulatory procedures to have the greatest effect. We aimed to summarize the current knowledge on optimization of neuromodulatory therapies for AF and discuss the challenges and future directions for research in this area.

Recent Findings

In recent years, the switch from invasive to non-invasive neuromodulatory approaches has made it possible to conduct clinical studies using at-home self-administrated devices to evaluate long-term effects. In this regard, transcutaneous auricular vagus nerve stimulation (ta-VNS) has received more attention, to the extent that clinical studies have determined its beneficial effects on reducing AF burden and atrial alternans in paroxysmal AF patients within 6 months. P-wave alternans, reflecting beat to beat variation in P wave amplitude, has been recently introduced as a predictive biomarker for acute and chronic responses to ta-VNS that can be useful in optimizing patient selection and stimulation parameters.

Summary

Optimizing patient selection and stimulation parameters is critical for maximizing the patient-specific, on-target favorable effects of neuromodulatory treatments while minimizing their off-target effects. Identifying biomarkers that can predict acute and chronic responses to neuromodulatory treatment is critical in achieving optimal neuromodulation.

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  1. Cardiovascular Diseases Research Institute, Tehran Heart Center, Tehran University of Medical Sciences, Tehran, Iran

    Danesh Soltani

  2. University of Oklahoma Health Sciences Center, 800 Stanton L Young Blvd, Suite 5400, Oklahoma City, OK, 73104, USA

    Stavros Stavrakis

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Soltani, D., Stavrakis, S. Neuromodulation for the Management of Atrial Fibrillation—How to Optimize Patient Selection and the Procedural Approach. Curr Cardiovasc Risk Rep 17, 91–102 (2023). https://doi.org/10.1007/s12170-023-00718-1

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