Role of the autonomic nervous system in modulating cardiac arrhythmias

Mark J. Shen, Douglas P. Zipes

Research output: Contribution to journalArticle

280 Citations (Scopus)

Abstract

The autonomic nervous system plays an important role in the modulation of cardiac electrophysiology and arrhythmogenesis. Decades of research has contributed to a better understanding of the anatomy and physiology of cardiac autonomic nervous system and provided evidence supporting the relationship of autonomic tone to clinically significant arrhythmias. The mechanisms by which autonomic activation is arrhythmogenic or antiarrhythmic are complex and different for specific arrhythmias. In atrial fibrillation, simultaneous sympathetic and parasympathetic activations are the most common trigger. In contrast, in ventricular fibrillation in the setting of cardiac ischemia, sympathetic activation is proarrhythmic, whereas parasympathetic activation is antiarrhythmic. In inherited arrhythmia syndromes, sympathetic stimulation precipitates ventricular tachyarrhythmias and sudden cardiac death except in Brugada and J-wave syndromes where it can prevent them. The identification of specific autonomic triggers in different arrhythmias has brought the idea of modulating autonomic activities for both preventing and treating these arrhythmias. This has been achieved by either neural ablation or stimulation. Neural modulation as a treatment for arrhythmias has been well established in certain diseases, such as long QT syndrome. However, in most other arrhythmia diseases, it is still an emerging modality and under investigation. Recent preliminary trials have yielded encouraging results. Further larger-scale clinical studies are necessary before widespread application can be recommended.

Original languageEnglish
Pages (from-to)1004-1021
Number of pages18
JournalCirculation Research
Volume114
Issue number6
DOIs
StatePublished - Mar 14 2014

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Autonomic Nervous System
Cardiac Arrhythmias
Cardiac Electrophysiology
Long QT Syndrome
Sudden Cardiac Death
Ventricular Fibrillation
Tachycardia
Atrial Fibrillation
Anatomy
Ischemia
Research

Keywords

  • atrial fibrillation
  • autonomic nervous system
  • ventricular fibrillation

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Role of the autonomic nervous system in modulating cardiac arrhythmias. / Shen, Mark J.; Zipes, Douglas P.

In: Circulation Research, Vol. 114, No. 6, 14.03.2014, p. 1004-1021.

Research output: Contribution to journalArticle

Shen, Mark J. ; Zipes, Douglas P. / Role of the autonomic nervous system in modulating cardiac arrhythmias. In: Circulation Research. 2014 ; Vol. 114, No. 6. pp. 1004-1021.
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