Autonomic modulation of ventricular electrical activity: recent developments and clinical implications
Author: Valerie Y H van Weperen1,2, Marc A Vos1, Olujimi A Ajijola3
Affiliation:
1 Department of Medical Physiology, Universitair Medisch Centrum Utrecht, Utrecht, The Netherlands.
2 UCLA Cardiac Arrhythmia Center, UCLA Neurocardiology Research Center, UCLA Neurocardiology Research Program of Excellence, David Geffen School of Medicine at UCLA, University of California, 100 Medical Plaza, Suite 660, Westwood Blvd, Los Angeles, CA, 90095-1679, USA.
3 UCLA Cardiac Arrhythmia Center, UCLA Neurocardiology Research Center, UCLA Neurocardiology Research Program of Excellence, David Geffen School of Medicine at UCLA, University of California, 100 Medical Plaza, Suite 660, Westwood Blvd, Los Angeles, CA, 90095-1679, USA. oajijola@mednet.ucla.edu.
Conference/Journal: Clin Auton Res
Date published: 2021 Sep 30
Other:
Special Notes: doi: 10.1007/s10286-021-00823-4. , Word Count: 194
Purpose:
This review aimed to provide a complete overview of the current stance and recent developments in antiarrhythmic neuromodulatory interventions, focusing on lifethreatening vetricular arrhythmias.
Methods:
Both preclinical studies and clinical studies were assessed to highlight the gaps in knowledge that remain to be answered and the necessary steps required to properly translate these strategies to the clinical setting.
Results:
Cardiac autonomic imbalance, characterized by chronic sympathoexcitation and parasympathetic withdrawal, destabilizes cardiac electrophysiology and promotes ventricular arrhythmogenesis. Therefore, neuromodulatory interventions that target the sympatho-vagal imbalance have emerged as promising antiarrhythmic strategies. These strategies are aimed at different parts of the cardiac neuraxis and directly or indirectly restore cardiac autonomic tone. These interventions include pharmacological blockade of sympathetic neurotransmitters and neuropeptides, cardiac sympathetic denervation, thoracic epidural anesthesia, and spinal cord and vagal nerve stimulation.
Conclusion:
Neuromodulatory strategies have repeatedly been demonstrated to be highly effective and very promising anti-arrhythmic therapies. Nevertheless, there is still much room to gain in our understanding of neurocardiac physiology, refining the current neuromodulatory strategic options and elucidating the chronic effects of many of these strategic options.
Keywords: Arrhythmogenesis; Cardiac electrophysiology; Neural remodeling; Sympathetic nerves.
PMID: 34591191 DOI: 10.1007/s10286-021-00823-4
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