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Cardiac autonomic innervation

  • CME ARTICLE Review Article
  • Published:
Journal of Nuclear Cardiology Aims and scope

Abstract

The autonomic nervous system plays a key role in regulating changes in the cardiovascular system and its adaptation to various human body functions. The sympathetic arm of the autonomic nervous system is associated with the fight and flight response, while the parasympathetic division is responsible for the restorative effects on heart rate, blood pressure, and contractility. Disorders involving these two divisions can lead to, and are seen as, a manifestation of most common cardiovascular disorders. Over the last few decades, extensive research has been performed establishing imaging techniques to quantify the autonomic dysfunction associated with various cardiovascular disorders. Additionally, several techniques have been tested with variable success in modulating the cardiac autonomic nervous system as treatment for these disorders. In this review, we summarize basic anatomy, physiology, and pathophysiology of the cardiac autonomic nervous system including adrenergic receptors. We have also discussed several imaging modalities available to aid in diagnosis of cardiac autonomic dysfunction and autonomic modulation techniques, including pharmacologic and device-based therapies, that have been or are being tested currently.

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Abbreviations

NTS:

Nucleus tractus solitarius

IML:

Intermediolateral nucleus

RVLM:

Rostral ventrolateral medulla

CVLM:

Caudal ventrolateral medulla

NA:

Nucleus ambiguous

DMV:

Dorsal motor nucleus of vagus

123I-MIBG:

123I-metaiodobenzylguanidine

H/M ratio:

Heart-mediastinum ratio

VNS:

Vagus nerve stimulation

SCS:

Spinal cord stimulation

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Acknowledgements

The authors thank Ronald W. Millard, Ph.D. for his careful review of the manuscript and thoughtful suggestions.

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Authors and Affiliations

  1. Division of Cardiovascular Health and Disease, Department of Internal Medicine, University of Cincinnati College of Medicine, P.O. Box 670542, Cincinnati, OH, USA

    Hina K. Jamali MD, Fahad Waqar MD & Myron C. Gerson MD

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  1. Hina K. Jamali MD
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  2. Fahad Waqar MD
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Correspondence to Myron C. Gerson MD.

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Funded in part by the John Strauss Fund for Research and Education in Cardiovascular Imaging.

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Addendum

At the time of review of the manuscript proofs, a significant new contribution became available concerning the role of renal sympathetic stimulation causing ventricular arrhythmias. This retrospective, propensity-matched study of 16 patients with refractory ventricular arrhythmias treated with catheter ablation plus renal sympathetic denervation provided a comparison to 16 patients treated with catheter ablation alone. With a median follow-up of 15 months, there was a significant decrease in burden of ventricular tachycardia/ventricular fibrillation and of anti-tachycardia pacing/shock therapies delivered in the group that received adjunctive renal sympathetic denervation therapy (p < 0.05).119

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Jamali, H.K., Waqar, F. & Gerson, M.C. Cardiac autonomic innervation. J. Nucl. Cardiol. 24, 1558–1570 (2017). https://doi.org/10.1007/s12350-016-0725-7

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