Author + information
- Received March 27, 2019
- Revision received May 30, 2019
- Accepted June 4, 2019
- Published online August 19, 2019.
- University of California, Los Angeles (UCLA) Cardiac Arrhythmia Center and Neurocardiology Research Program of Excellence, David Geffen School of Medicine, UCLA, Los Angeles, California
- ↵∗Address for correspondence:
Dr. Kalyanam Shivkumar, UCLA Cardiac Arrhythmia Center, UCLA Neurocardiology Research Program, David Geffen School of Medicine at UCLA, 100 Medical Plaza, Suite 660, Westwood Boulevard, Los Angeles, California 90095-1679.
• Autonomic imbalance is inextricably linked with cardiac arrhythmias and has become an important therapeutic target.
• Recent advances in neuromodulatory techniques have shown promise in treating VT and AF.
• Further investigation into basic mechanisms of cardiac neural control is needed to improve antiarrhythmic therapies.
Autonomic dysregulation in cardiovascular disease plays a major role in the pathogenesis of arrhythmias. Cardiac neural control relies on complex feedback loops consisting of efferent and afferent limbs, which carry sympathetic and parasympathetic signals from the brain to the heart and sensory signals from the heart to the brain. Cardiac disease leads to neural remodeling and sympathovagal imbalances with arrhythmogenic effects. Preclinical studies of modulation at central and peripheral levels of the cardiac autonomic nervous system have yielded promising results, leading to early stage clinical studies of these techniques in atrial fibrillation and refractory ventricular arrhythmias, particularly in patients with inherited primary arrhythmia syndromes and structural heart disease. However, significant knowledge gaps in basic cardiac neurophysiology limit the success of these neuromodulatory therapies. This review discusses the recent advances in neuromodulation for cardiac arrhythmia management, with a clinical scenario-based approach aimed at bringing neurocardiology closer to the realm of the clinical electrophysiologist.
- cardiac autonomic nervous system
- cardiac ganglionated plexi
- cardiac sympathetic denervation
- stellate ganglion
- vagal nerve stimulation
↵∗ Drs. Hanna and Rajendran contributed equally to this work.
Drs. Rajendran and Shivkumar are co-founders of NeuCures, Inc. Dr. Shivkumar was supported by National Institutes of Health grants HL084261 and OT2OD023848. UCLA has patents developed by Dr. Shivkumar relating to cardiac neural diagnostics and therapeutics. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received March 27, 2019.
- Revision received May 30, 2019.
- Accepted June 4, 2019.
- 2019 American College of Cardiology Foundation
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