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Fundamental Neurocardiology: The Intracardiac Nervous System

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Heart Rate and Rhythm

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Abstract

Cardiac output is controlled by the autonomic nervous system to meet continually changing demands for the perfusion of systemic vascular beds. Dysfunction of autonomic control can contribute to a range of cardiopathies; conversely, robust autonomic function can help maintain a failing myocardium as heart diseases progress. Understanding the structure and operation of the intracardiac nervous system is thus essential to guide the formation of novel neuronally-directed cardiac therapies. Neural control of the heart operates through a hierarchy of interconnected reflex loops at the levels of the intracardiac neural network, the extracardiac intrathoracic ganglia and medullary and spinal autonomic nuclei. Within this hierarchy, the intracardiac nervous system represents the final common pathway for local cardiac control, capable of modulating chronotropy, dromotropy and inotropy on a fast, beat-by-beat basis. Intracardiac neurons constitute a series of interconnected ganglionated plexi distributed throughout the atrial walls and around the atrioventricular border; plexus nerves innervate all regions of the heart. This chapter reviews the position of the intracardiac nervous system in the autonomic control hierarchy and summarizes current knowledge of the neuroanatomy, physiology and potential roles of neuronal populations in cardiac control. Opportunities for future research to address remaining gaps in knowledge of this system are discussed in terms of the application of new tissue imaging technologies, genetic manipulations and novel experimental models.

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Authors and Affiliations

  1. Department of Medical Neuroscience, Faculty of Medicine, Dalhousie University, Halifax, NS, Canada

    Frank M. Smith

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Editors and Affiliations

  1. Cardiac Electrophysiology Division, Ion Channel Study Center, Life Science Academy, Lucknow, India

    Onkar N. Tripathi

  2. Department of Physiology and Biophysics, Dalhousie University, Halifax, Canada

    T. Alexander Quinn

  3. Institute for Experimental Cardiovascular Medicine, University Heart Center and Faculty of Medicine, University of Freiburg, Freiburg, Germany

    Ursula Ravens

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Smith, F.M. (2023). Fundamental Neurocardiology: The Intracardiac Nervous System. In: Tripathi, O.N., Quinn, T.A., Ravens, U. (eds) Heart Rate and Rhythm. Springer, Cham. https://doi.org/10.1007/978-3-031-33588-4_8

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