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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...

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Autores principales: 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
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
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”.
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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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