Innervation of the heart: An invisible grid within a black box,☆☆

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Abstract

Autonomic control of cardiovascular function is mediated by a complex interplay between central, peripheral, and innate cardiac components. This interplay is what mediates the normal cardiovascular response to physiologic and pathologic stressors, including blood pressure, cardiac contractile function, and arrhythmias. However, in order to understand how modern therapies directly affecting autonomic function may be harnessed to treat various cardiovascular disease states requires an intimate understanding of anatomic and physiologic features of the innervation of the heart. Thus, in this review, we focus on defining features of the central, peripheral, and cardiac components of cardiac innervation, how each component may contribute to dysregulation of normal cardiac function in various disease states, and how modulation of these components may offer therapeutic options for these diseases.

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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    The author has indicated there are no conflicts of interest.

    ☆☆

    C.V.D. is supported by an NIH, USA, T32 Training Grant HL#007111.

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