Abstract
The cardiac autonomic nervous system (cANS) regulates cardiac adaptation to different demands. The heart is an asymmetrical organ, and in the selection of adequate treatment of cardiac diseases it may be relevant to take into account that the cANS also has sidedness as well as regional differences in anatomical, functional, and molecular characteristics. The left and right ventricles respond differently to adrenergic stimulation. Isoforms of nitric oxide synthase, which plays an important role in parasympathetic function, are also distributed asymmetrically across the heart. Treatment of cardiac disease heavily relies on affecting left-sided heart targets which are thought to apply to the right ventricle as well. Functional studies of the right ventricle have often been neglected. In addition, many principles have only been investigated in animals and not in humans. Anatomical and functional heterogeneity of the cANS in human tissue or subjects is highly valuable for understanding left- and right-sided cardiac pathology and for identifying novel treatment targets and modalities. Within this perspective, we aim to provide an overview and synthesis of anatomical and functional heterogeneity of the cANS in tissue or subjects, focusing on the human heart.
Highlights
The cardiac autonomic nervous system adapts the responses of the heart to external demands
We show that the human peripheral cardiac autonomic nervous system (cANS) shows considerable asymmetry, interindividual variations, and regional differences in anatomical, functional and molecular characteristics
The presence of the left-sided thoracic cardiac branch is highly variable, the localization of the cardiac plexus is higher on the right side compared to the left, and different parts of the cardiac plexus give rise to nerves innervating different parts of the heart
Summary
The cardiac autonomic nervous system (cANS) adapts the responses of the heart to external demands. It consists of a sympathetic part, which adapts cardiac function to physical activity and stress, and a parasympathetic part, which adapts it to a resting and restorative state. Under physiological conditions these systems are balanced and cardiac responses will be fine-tuned to differentiating demands. Asymmetry in Cardiac Innervation activity is lost This is caused by an increased activity of the sympathetic part of the cANS and/or diminished activity of the parasympathetic part and is associated with an adverse prognosis. Other cardiac diseases show a relation to cardiac sidedness and region and are heavily influenced by autonomic innervation, such as cardiac arrhythmias originating from the region of the pulmonary veins, ligament of Marshall and the RV outflow tract (Wickramasinghe and Patel, 2013)
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