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Neural Regulation of the Heart in Health and Disease

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Electrical Diseases of the Heart

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Abstract

Understanding of the role of autonomic nervous system activity in health and disease has continued to evolve in a fascinating and productive manner. Significant strides have been made in recent years to elucidate the intricacies of neural control of heart rhythm and the mechanisms whereby excess sympathetic nerve activity can provoke life-threatening arrhythmias. Autonomic factors impact the genesis of both atrial and ventricular arrhythmias. Of particular significance is our increased recognition of the importance of the process of neural remodeling following myocardial infarction, which has provided important clues regarding the factors that impact on recovery of risk for sudden death. The role of behavioral influences including intense emotion and sleep states are also reviewed.

New clinical tools have been developed for evaluating neurocardiac interactions including heart rate turbulence, deceleration capacity, and T-wave alternans. These noninvasive ECG-based parameters have proved to be clinically useful in identifying individuals who are at risk for life-threatening arrhythmias.

Promising nerve stimulation strategies including vagus nerve activation and spinal cord stimulation have progressed from animal testing to clinical trials. Progress in both the experimental and clinical domains is reviewed.

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Acknowledgements.

The authors thank Sandra S. Verrier for her editorial assistance.

Funding

No financial support was received for preparation of this review.

Disclosures

Dr. Verrier receives royalty income from Georgetown University and Beth Israel Deaconess Medical Center for intellectual property licensed to GE Healthcare and to Medtronic.

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Authors and Affiliations

  1. Cardiovascular Medicine Division, Medicine Department, Beth Israel Deaconess Medical Center, Harvard Medical School, 99 Brookline Ave., RN 301, Boston, MA, 02215, USA

    Richard L. Verrier PhD

  2. Cardiovascular Medicine Division, Medicine Department, Beth Israel Deaconess Medical Center, Harvard Medical School, 185 Pilgrim Rd., Baker Bldg., 4th Floor, Boston, MA, 02215, USA

    Alex Tan MD

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Correspondence to Richard L. Verrier PhD .

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  1. , Department of Internal Medicine, UMDNJ-RWJ Medical School, Robert Wood Johnson Pl. 1, New Brunswick, 08903-0019, New Jersey, USA

    Ihor Gussak

  2. , Gordon K. Moe Scholar, Masonic Medical Research Laboratory, Bleecker Street, Utica, 13501-1787, New York, USA

    Charles Antzelevitch

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Verrier, R.L., Tan, A. (2013). Neural Regulation of the Heart in Health and Disease. In: Gussak, I., Antzelevitch, C. (eds) Electrical Diseases of the Heart. Springer, London. https://doi.org/10.1007/978-1-4471-4881-4_5

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