Neurogenic Atrial Fibrillation Due to Insular Cortex Involvement

Mechanism and Clinical Implications

• The American College of Cardiology, American Heart Association, and European Society of Cardiology guidelines recognize that autonomic influences play an important role in the initiation of atrial fibrillation, with fluctuations in autonomic tone occurring prior to AF development, and list "neurogenic" causes under predisposing factors, specifically mentioning subarachnoid hemorrhage and nonhemorrhagic major stroke 1, 2
• Insular cortex damage disrupts the balance between sympathetic and vagal influences, which is as important as absolute autonomic tone in predicting AF, according to the American College of Cardiology, American Heart Association, and European Society of Cardiology guidelines 1, 2