Cardiac Innervation: Pathophysiology and Therapeutics

Abstract

Cardiac neurotransmission via afferents and efferent cardiac nerves modulates key physiological functions of the heart (chronotropy, dromotropy, lusitropy, and inotropy). The processing of cardiac afferent signals at various levels of the neuraxis (intrinsic cardiac nervous system, extracardiac‐intrathoracic ganglia, spinal cord, brain stem, and higher centers), is required for the fine efferent cardiomotor control via the sympathetic and parasympathetic nerves. These reflex feedback loops provide precise regulation of sympathetic–parasympathetic balance in the heart under normal conditions and during periods of increased physiological demands for a higher cardiac output. This system plays a crucial role in the pathophysiology and progression of heart disease (heart failure and arrhythmias that lead to sudden cardiac death). Short term adaptations seen after cardiac injury become maladaptive in the intermediate and long term resulting in adverse outcomes. There is structural and functional remodeling of the neural structures that control the heart following cardiac injury. There are multiple avenues for cardiac neuromodulation and some of these approaches are now being utilized in specialized centers. Several recent advances in scientific methods have improved our understanding the cellular and molecular processes involved in innervation and the functional control of the myocardium in health and disease. This knowledge is strengthening the mechanistic framework to develop targeted neuraxial therapies for preventing cardiac disease progression and sudden cardiac death.Support or Funding InformationR01HL084261, OT2OD023848This abstract is from the Experimental Biology 2019 Meeting. There is no full text article associated with this abstract published in The FASEB Journal.