Meng Lingjin, Shivkumar Kalyanam, Ajijola Olujimi
UCLA Cardiac Arrhythmia Center and Neurocardiology Research Center of Excellence, Los Angeles, CA, USA.
UCLA Cardiac Arrhythmic Center, UCLA Health System, David Geffen School of Medicine at UCLA, Suite 600, Westwood Blvd, Los Angeles, CA, 90095-1679, USA.
Curr Treat Options Cardiovasc Med. 2018 Apr 7;20(5):38. doi: 10.1007/s11936-018-0633-z.
Autonomic nervous system (ANS) has a crucial role of regulating cardiac function in the physiological state and contributes to the pathogenesis of arrhythmias in the diseased state. The cardiac neuraxis consists of multiple feedback loops consisting of efferent and afferent limbs, mediating neurotransmission to and from the heart. Efferent parasympathetic neurotransmission is mediated by the vagus nerve, while paravertebral sympathetic ganglia relay efferent sympathetic neurotransmission to the heart. The association between autonomic activity and ventricular arrhythmias (VAs) has been studied extensively in both experimental models and humans. Efferent parasympathetic activity is felt to be antiarrhythmic, while the activation of efferent sympathetic signals is proarrhythmic. The cardiac neuraxis undergoes remodeling and becomes dysfunctional in the setting of myocardial infarction (MI), chronic cardiomyopathy (CMY), and structural heat disease. Altered ANS function has been shown to initiate and/or maintain VAs via various mechanisms. Interventions targeting the ANS have been used clinically to treat VAs, particularly in patients with hereditary heart rhythm disorders and structurally abnormal hearts. Clinical applications of cardiac neuraxial modulation at the level of spinal cord, stellate ganglion, and peripheral sympathetic and vagus nerve are being developed. In this review, the anatomy of cardiac autonomic innervation, the association between autonomic activity and ventricular arrhythmogenesis, and clinical applications of neuraxial modulation in the treatment of VAs are discussed.
自主神经系统（ANS）在生理状态下对调节心脏功能起着关键作用，在疾病状态下则参与心律失常的发病机制。心脏神经轴由多个反馈回路组成，这些回路包含传出和传入分支，介导心脏与外界之间的神经传递。传出副交感神经传递由迷走神经介导，而椎旁交感神经节将传出交感神经传递中继至心脏。自主神经活动与室性心律失常（VAs）之间的关联已在实验模型和人类中进行了广泛研究。传出副交感神经活动被认为具有抗心律失常作用，而传出交感神经信号的激活则具有促心律失常作用。在心肌梗死（MI）、慢性心肌病（CMY）和结构性心脏病的情况下，心脏神经轴会发生重塑并功能失调。已表明自主神经系统功能改变可通过多种机制引发和/或维持室性心律失常。针对自主神经系统的干预措施已在临床上用于治疗室性心律失常，特别是在患有遗传性心律紊乱和心脏结构异常的患者中。目前正在开发脊髓、星状神经节以及外周交感神经和迷走神经水平的心脏神经轴调制的临床应用。在这篇综述中，将讨论心脏自主神经支配的解剖结构、自主神经活动与室性心律失常发生之间的关联以及神经轴调制在室性心律失常治疗中的临床应用。
