Abstract
Dysfunction of the autonomic nervous system has been implicated in the pathogenesis of cardiovascular disease, including congestive heart failure and cardiac arrhythmias. Despite advances in the medical and surgical management of these entities, progression of disease persists as does the risk for sudden cardiac death. With improved knowledge of the dynamic relationships between the nervous system and heart, neuromodulatory techniques such as cardiac sympathetic denervation and vagal nerve stimulation (VNS) have emerged as possible therapeutic approaches for the management of these disorders. In this review, we present the structure and function of the cardiac nervous system and the remodeling that occurs in disease states, emphasizing the concept of increased sympathoexcitation and reduced parasympathetic tone. We review preclinical evidence for vagal nerve stimulation, and early results of clinical trials in the setting of congestive heart failure. Vagal nerve stimulation, and other neuromodulatory techniques, may improve the management of cardiovascular disorders, and warrant further study.
Highlights
The autonomic nervous system regulates all aspects of cardiac function, including chronotropy, inoptroy, dromotropy, and lusitropy (Fukuda et al, 2015)
In the setting of myocardial infarction, our group has shown that processing of afferent and efferent neural signals in the intrinsic cardiac nervous system (ICNS) is impaired, with overall decreased network connectivity, suggesting an inability of neurons to respond to local myocardial stimuli (Rajendran et al, 2016)
Multiple cardiovascular disorders including myocardial infarction and congestive heart failure result in excessive sympatoexcitation and a withdrawal of central parasympathetic tone (Ardell et al, 2016; Shivkumar et al, 2016)
Summary
Reviewed by: Peter John Schwartz, Istituto Auxologico Italiano (IRCCS), Italy David Mendelowitz, George Washington University, United States. Dysfunction of the autonomic nervous system has been implicated in the pathogenesis of cardiovascular disease, including congestive heart failure and cardiac arrhythmias. With improved knowledge of the dynamic relationships between the nervous system and heart, neuromodulatory techniques such as cardiac sympathetic denervation and vagal nerve stimulation (VNS) have emerged as possible therapeutic approaches for the management of these disorders. We present the structure and function of the cardiac nervous system and the remodeling that occurs in disease states, emphasizing the concept of increased sympathoexcitation and reduced parasympathetic tone. We review preclinical evidence for vagal nerve stimulation, and early results of clinical trials in the setting of congestive heart failure. Other neuromodulatory techniques, may improve the management of cardiovascular disorders, and warrant further study
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