Autonomic and surgical substrate modulation of atrial fibrillation

This thesis focuses on the effects of fibrosis and the autonomic nervous system on conduction in patients with atrial fibrillation and the surgical ablation of the atria and autonomic nervous system as treatment of atrial fibrillation. Atrial fibrillation is the most common arrhythmia and results from multiple pathophysiological mechanisms. Both fibrosis and the autonomic nervous system influence the occurrence and maintenance of AF. Animal and clinical studies have shown that the parasympathetic and sympathetic nervous system exert arrhythmogenic electrophysiological effects on atrial myocardium and the pulmonary veins. The atria have a dense network of interconnected nerves of both the parasympathetic and sympathetic nervous system. These nerves are concentrated in ganglion plexi, which can be ablation by epicardial radiofrequency ablation during surgery. This thesis presents clinical and experimental studies in which the effects of the autonomic nervous system on conduction properties of fibrotic human atria of patients with atrial fibrillation are investigated. Additionally the results of electrophysiological guided thoracoscopic pulmonary vein isolation and autonomic modulation for the treatment of atrial fibrillation are presented.