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The cardiac autonomic nervous system: an introduction

Das kardiale autonome Nervensystem: eine Einführung

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Abstract

In recent decades, numerous anatomical and physiological studies of the cardiac autonomic nervous system (ANS) have investigated the complex relationships between the brain and the heart. Autonomic activation not only alters heart rate, conduction, and hemodynamics, but also cellular and subcellular properties of individual myocytes. Moreover, the cardiac ANS plays an essential role in cardiac arrhythmogenesis. There is mounting evidence that neural modulation either by ablation or stimulation can effectively control a wide spectrum of cardiac arrhythmias. This article discusses anatomic aspects of the cardiac ANS, focusing on how autonomic activities influence cardiac electrophysiology. Specific autonomic triggers of various cardiac arrhythmias, in particular atrial fibrillation (AF) and ventricular arrhythmias, are also briefly discussed. Studies with heart-rate variability analysis indicate that, rather than being triggered by either vagal or sympathetic activity, the onset of AF can be associated with simultaneous discharge of both limbs, leading to an imbalance between these two arms of the cardiac ANS. At the same time, sudden cardiac death resulting from ventricular arrhythmias continues to be a significant health and societal burden. These nerve activities of the cardiac ANS can be targeted for the treatment for cardiac arrhythmias, in particular AF and ventricular tachyarrhythmias.

Zusammenfassung

In jüngster Zeit wurde das komplexe Wechselspiel zwischen Gehirn und Herz in zahlreichen anatomischen und physiologischen Studien zum kardialen autonomen Nervensystem (ANS) untersucht. Autonome Aktivierung verändert nicht nur die Herzschlagfrequenz, die Reizleitung und die Hämodynamik, sondern auch zelluläre und subzelluläre Eigenschaften einzelner Myozyten. Hinzu kommt die essenzielle Rolle, die das ANS bei kardialen Arrhythmien spielt. Es gibt zunehmende Evidenz, dass neurale Modulation, entweder durch Ablation oder Stimulation, ein breites Spektrum an Herzrhythmusstörungen wirksam kontrollieren kann. Im vorliegenden Beitrag werden die anatomischen Aspekte des ANS diskutiert, wobei die Frage, wie kardiale Elektrophysiologie durch autonome Einflüsse verändert wird, im Fokus steht. Spezifische autonome Trigger verschiedener kardialer Arrhythmien, insbesondere von Vorhofflimmern und ventrikulären Arrhythmien, werden ebenfalls kurz diskutiert. Analysen der Herzfrequenzvariabilität ergaben, dass die Manifestation von Vorhofflimmern eher mit simultanen Entladungen beider Schenkel assoziiert ist, die zu einer Dysbalance zwischen diesen beiden Teilen des ANS führen, als durch vagale oder sympathische Aktivität allein. Gleichzeitig stellt der plötzliche Herztod aufgrund ventrikulärer Arrhythmien eine signifikante gesundheitliche und gesellschaftliche Belastung dar. Behandlungsmaßnahmen bei Herzrhythmusstörungen, insbesondere bei Vorhofflimmern und ventrikulären Tachyarrhythmien, könnten auf eine Beeinflussung dieser Effekte des kardialen autonomen Nervensystems abzielen.

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  1. Prairie Heart Institute, HSHS St. John’s Hospital, 619 E Mason St, 62701, Springfield, IL, USA

    Mark J. Shen MD

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For this article no studies with human participants or animals were performed by any of the authors. All studies mentioned were performed in accordance with the ethical standards indicated in each case.

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Shen, M.J. The cardiac autonomic nervous system: an introduction. Herzschr Elektrophys 32, 295–301 (2021). https://doi.org/10.1007/s00399-021-00776-1

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