Abstract
Although the heart has an innate ability to generate its own electrical impulses, proper cardiac function is heavily dependent on hormonal and neuronal modulations. The extensive innervation of the heart by afferent and efferent neurons 1 Armour J.A. Functional anatomy of intrathoracic neurons innervating the atria and ventricles. Heart Rhythm. 2010; 7: 994-996 Abstract Full Text Full Text PDF PubMed Scopus (51) Google Scholar stress the important role of the autonomic nervous system (ANS) in controlling its proper function under dynamic changes in the environment. The direct effects of sympathetic and parasympathetic transmitters on the physiological properties of cardiac cells have been known for many years and are relatively well described. However, the integrative function and delicate balance between complex ANS networks innervating the heart have only lately been substantiated. There is increasing evidence that abnormal ANS function may have an important role in various cardiac pathologies. Moreover, autonomic modulation emerges as a new paradigm that may effectively treat challenging conditions such as drug-refractory vasovagal syncope and severe heart failure. 2 Yao Y. Shi R. Wong T. et al. Endocardial autonomic denervation of the left atrium to treat vasovagal syncope: an early experience in humans. Circ Arrhythm Electrophysiol. 2012; 5: 279-286 Crossref PubMed Scopus (83) Google Scholar , 3 De Ferrari G.M. Crijns H.J. Borggrefe M. et al. Chronic vagus nerve stimulation: a new and promising therapeutic approach for chronic heart failure. Eur Heart J. 2011; 32: 847-855 Crossref PubMed Scopus (377) Google Scholar Along these lines, numerous pieces of recent evidence indicate that neuronal mechanisms are critical determinants of atrial arrhythmogenesis. 4 Shen M.J. Choi E.K. Tan A.Y. et al. Neural mechanisms of atrial arrhythmias. Nat Rev Cardiol. 2012; 9: 30-39 Crossref Scopus (119) Google Scholar Spinal cord stimulation protects against atrial fibrillation induced by tachypacingHeart RhythmVol. 9Issue 9PreviewSpinal cord stimulation (SCS) has been shown to modulate atrial electrophysiology and confer protection against ischemia and ventricular arrhythmias in animal models. Full-Text PDF
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