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The Autonomic Coumel Triangle: A New Way to Define the Fascinating Relationship between Atrial Fibrillation and the Autonomic Nervous System
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 (AN...
Autores principales: | , , , , , , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2023
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10221094/ https://www.ncbi.nlm.nih.gov/pubmed/37240784 http://dx.doi.org/10.3390/life13051139 |
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author | Rebecchi, Marco Fanisio, Francesca Rizzi, Fabio Politano, Alessandro De Ruvo, Ermenegildo Crescenzi, Cinzia Panattoni, Germana Squeglia, Marianna Martino, Annamaria Sasso, Stefano Golia, Paolo Pugliese, Giulia Del Gigante, Sofia Giamundo, Domenico Desimone, Pietro Grieco, Domenico De Luca, Lucia Giordano, Ignazio Barillà, Francesco Perrone, Marco Alfonso Calò, Leonardo Iellamo, Ferdinando |
author_facet | Rebecchi, Marco Fanisio, Francesca Rizzi, Fabio Politano, Alessandro De Ruvo, Ermenegildo Crescenzi, Cinzia Panattoni, Germana Squeglia, Marianna Martino, Annamaria Sasso, Stefano Golia, Paolo Pugliese, Giulia Del Gigante, Sofia Giamundo, Domenico Desimone, Pietro Grieco, Domenico De Luca, Lucia Giordano, Ignazio Barillà, Francesco Perrone, Marco Alfonso Calò, Leonardo Iellamo, Ferdinando |
author_sort | Rebecchi, Marco |
collection | PubMed |
description | 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”. |
format | Online Article Text |
id | pubmed-10221094 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-102210942023-05-28 The Autonomic Coumel Triangle: A New Way to Define the Fascinating Relationship between Atrial Fibrillation and the Autonomic Nervous System Rebecchi, Marco Fanisio, Francesca Rizzi, Fabio Politano, Alessandro De Ruvo, Ermenegildo Crescenzi, Cinzia Panattoni, Germana Squeglia, Marianna Martino, Annamaria Sasso, Stefano Golia, Paolo Pugliese, Giulia Del Gigante, Sofia Giamundo, Domenico Desimone, Pietro Grieco, Domenico De Luca, Lucia Giordano, Ignazio Barillà, Francesco Perrone, Marco Alfonso Calò, Leonardo Iellamo, Ferdinando Life (Basel) Review 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”. MDPI 2023-05-08 /pmc/articles/PMC10221094/ /pubmed/37240784 http://dx.doi.org/10.3390/life13051139 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Review Rebecchi, Marco Fanisio, Francesca Rizzi, Fabio Politano, Alessandro De Ruvo, Ermenegildo Crescenzi, Cinzia Panattoni, Germana Squeglia, Marianna Martino, Annamaria Sasso, Stefano Golia, Paolo Pugliese, Giulia Del Gigante, Sofia Giamundo, Domenico Desimone, Pietro Grieco, Domenico De Luca, Lucia Giordano, Ignazio Barillà, Francesco Perrone, Marco Alfonso Calò, Leonardo Iellamo, Ferdinando The Autonomic Coumel Triangle: A New Way to Define the Fascinating Relationship between Atrial Fibrillation and the Autonomic Nervous System |
title | The Autonomic Coumel Triangle: A New Way to Define the Fascinating Relationship between Atrial Fibrillation and the Autonomic Nervous System |
title_full | The Autonomic Coumel Triangle: A New Way to Define the Fascinating Relationship between Atrial Fibrillation and the Autonomic Nervous System |
title_fullStr | The Autonomic Coumel Triangle: A New Way to Define the Fascinating Relationship between Atrial Fibrillation and the Autonomic Nervous System |
title_full_unstemmed | The Autonomic Coumel Triangle: A New Way to Define the Fascinating Relationship between Atrial Fibrillation and the Autonomic Nervous System |
title_short | The Autonomic Coumel Triangle: A New Way to Define the Fascinating Relationship between Atrial Fibrillation and the Autonomic Nervous System |
title_sort | autonomic coumel triangle: a new way to define the fascinating relationship between atrial fibrillation and the autonomic nervous system |
topic | Review |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10221094/ https://www.ncbi.nlm.nih.gov/pubmed/37240784 http://dx.doi.org/10.3390/life13051139 |
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