The autonomic cardiac nervous system (ACNS) is physiolog- ically important and plays a major role in development and maintenance of atrial fibrillation (AF), which has been inves- tigated accordingly in recent studies.1,2 In particular, imbal- ance between the parasympathetic and sympathetic nervous system is likely to induce AF.2,3
Potential additional therapeutic approaches such as car- diac ganglionic ablation or denervation as well as noninva- sive approaches via electroacupuncture have delivered promising results concerning a reduction of AF episodes.4–7 In a canine model, low-level transcutaneous electrical stimu-
lation—defined as stimulation at a voltage approximately 10% beneath the threshold of vagus nerve stimulation inducing any slowing of sinus rate or atrioventricular conduc- tion—of the auricular branch of the vagus nerve (ABVN) showed antiarrhythmic effects by suppressing neural activity within the ganglionated plexi and thereby inhibiting induc- ibility of AF.7 In patients with paroxysmal AF, low-level vagal stimulation recently demonstrated significant reduction in AF burden.8