Innervation of the heart: An invisible grid within a black box☆,☆☆
Section snippets
Anatomic considerations
The anatomy and physiology of cardiac components of the autonomic nervous system has been well described in multiple reviews [1], [2], [3], [4]. Here, we offer a brief overview of the critical portions of the autonomic nervous system, including central and peripheral components in addition to the intrinsic cardiac nervous system. Via a basic understanding of these aspects, the reader may better understand current clinical studies into modulating the autonomic nervous system to treat a variety
Arrhythmogenesis
The role of the autonomic nervous system in arrhythmogenesis has been well described. Specific disease states in which advances in understanding of the autonomic nervous system have contributed to novel therapeutic targets include atrial fibrillation, ventricular arrhythmias, and inappropriate sinus tachycardia (we will focus on the first of these two in this review). Part of the reason for the increased tendency toward arrhythmias in certain patients may relate to remodeling of the autonomic
Future research considerations
Future research will need to focus on whether (a) specific negative effects may occur due to irreversible modulation of portions of the ANS, and (b) what potential side effects may exist from active modulation of different parts of the ANS. For example, whether irreversible ablation of epicardial cardiac ganglia or renal sympathetic nerves may have long-term unexpected negative effects is unknown, especially because of how much remains to be discovered about the degree of cross-linking that
Conclusion
The ANS comprises an elegant and complex series of interactions that directly impacts cardiovascular responses to physiologic stimuli and can play a large part in the pathogenesis of a variety of cardiac diseases. However, understanding these interactions may lend itself to an improved appreciation of the physiology underlying several different types of cardiac disease, ranging from arrhythmias to hypertension to syncope. In turn, recognizing at what levels one may directly affect input into
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2020, Indian Pacing and Electrophysiology JournalCitation Excerpt :Nor-epinephrine is the final neurotransmitter of these post-ganglionic neurons. The cardiac feedback to the autonomic NS is carried via these post-ganglionic neurons to the spinal cord and brainstem [28]. This sympathetic NS is concerned with the so called “fight or flight” response and is the main target for treating tachyarrhythmias.
Avoiding off-target effects in electrical stimulation of the cervical vagus nerve: Neuroanatomical tracing techniques to study fascicular anatomy of the vagus nerve
2019, Journal of Neuroscience MethodsCitation Excerpt :The deep cardiac plexus lies in front of the tracheal bifurcation behind the aortic arch and is formed by cardiac nerves arising from the cervical ganglia of the sympathetic trunk and cardiac branches of the vagus and recurrent laryngeal nerves. From an electrophysiological perspective, the right-sided nerves tend to supply the sinoatrial (SA) node while the left-sided nerves tend to supply the atrioventricular node (Kapa et al., 2016). In rats, direct injections of HRP (3–5 μl bolus of 30% HRP in saline) into the upper right atrium near SA node or in the mid-ventricular region were performed to trace vagal projections to the heart (Stuesse, 1982).
Sympathetic Innervation and Cardiac Arrhythmias
2018, Cardiac Electrophysiology: From Cell to Bedside: Seventh EditionEditorial Commentary: Tuning in to sympathetic activity cutaneously in humans—A bench to bedside saga
2017, Trends in Cardiovascular Medicine
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The author has indicated there are no conflicts of interest.