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Electrophysiology and Pathophysiology of the Autonomic Nervous System of the Heart

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Autonomic Innervation of the Heart

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Abstract

The autonomic nervous system has an important role in the genesis, maintenance, and interruption of arrhythmias. Characterisation of the extrinsic and intrinsic cardiac nervous systems dates back to studies from the 1930s and ranges from recognition of anatomic relationships at the gross anatomic level to discovery of chemoreceptors, mechanoreceptors, and ganglionated plexuses lining specific regions along the veins, arteries, and cardiac chambers. However, with the increasing recognition of anatomic and functional relationships between the nervous system and the heart, also comes a litany of new questions. Specifically, studies to date have revealed the large degree of complexity. Furthermore, the clinical correlation of ex vivo cell-based and isolated perfusion models of the heart has been limited due to anatomic accessibility in recording simultaneous neuronal and cardiac electrophysiologic activity during in vivo electrophysiology studies. Partly because of these limitations, the study of autonomic cardiac electrophysiology remains in its early stages, with several studies pointing towards potential novel and elegant methods of treating electrophysiologic disease, but much remains to be done to translate these findings into clinical practice. In this chapter, we will briefly discuss anatomic aspects of the extrinsic and intrinsic cardiac nervous systems, how these various ganglia and nerves may integrate in modulating cardiac electrophysiology, and their relationships to a variety of electrophysiologic diseases. We will also discuss both current and future avenues of research as they relate to the fundamental understanding of how the cardiac-autonomic interface may offer itself to novel therapeutic targets for treating electrophysiologic diseases.

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Abbreviations

ACEi:

Angiotensin-converting enzyme inhibitors

ACLS:

Advanced cardiac life support

AF:

Atrial fibrillation

ANS:

Autonomic nervous system

APD:

Action potential duration

ARI:

Activation recovery interval

BRS:

Baroreflex sensitivity

cAMP:

Cyclic adenosine monophosphate

EF:

Ejection fraction

ERP:

Effective refractory period

FHS:

Framingham heart study

HRV:

Heart rate variability

ICC:

Interstitial cells of Cajal

ICD:

Implantable cardioverter defibrillator

LAD:

Left anterior descending artery

MI:

Myocardial infarction

MIBG:

Metaiodobenzylguanidine

NADPH:

Nicotinamide adenine dinucleotide phosphate (NADPH)

PKA:

Protein kinase A

PVI:

Pulmonary vein isolation

SCD:

Sudden cardiac death

VF:

Ventricular fibrillation

VS:

Vagal stimulation

VT:

Ventricular tachycardia

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Authors and Affiliations

  1. Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, Brussel, 1090, Belgium

    Carlo de Asmundis MD, PhD

  2. Department of Cardiology, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, Brussel, 1090, Belgium

    Guy Van Camp MD, PhD

  3. Cardiovascular Division, Heart Rhythm Management Centre, Universitair Ziekenhuis Brussel, Vrije Universiteit Brussel, Laarbeeklaan 101, Brussel, 1090, Belgium

    Pedro Brugada MD, PhD

Authors
  1. Carlo de Asmundis MD, PhD
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  2. Guy Van Camp MD, PhD
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  3. Pedro Brugada MD, PhD
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Corresponding author

Correspondence to Carlo de Asmundis MD, PhD .

Editor information

Editors and Affiliations

  1. Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands

    Riemer H.J.A. Slart

  2. Thorax center Cardiology, University Medical Center Groningen, Groningen, The Netherlands

    René A. Tio

  3. Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, Groningen, The Netherlands

    Philip H. Elsinga

  4. Nuklearmedizinische Klinik, Klinikum Rechts der Isar Technische Universität München, München, Germany

    Markus Schwaiger

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de Asmundis, C., Van Camp, G., Brugada, P. (2015). Electrophysiology and Pathophysiology of the Autonomic Nervous System of the Heart. In: Slart, R., Tio, R., Elsinga, P., Schwaiger, M. (eds) Autonomic Innervation of the Heart. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-45074-1_2

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