Krul Sébastien P J, Berger Wouter R, Veldkamp Marieke W, Driessen Antoine H G, Wilde Arthur A M, Deneke Thomas, de Bakker Jacques M T, Coronel Ruben, de Groot Joris R
Heart Center, Department of Clinical and Experimental Cardiology, Academic Medical Center, Amsterdam, the Netherlands.
Heart Center, Department of Clinical and Experimental Cardiology, Academic Medical Center, Amsterdam, the Netherlands; Princess Al-Jawhara Al-Brahim Centre of Excellence in Research of Hereditary Disorders, Jeddah, Kingdom of Saudi Arabia.
JACC Clin Electrophysiol. 2015 Dec;1(6):496-508. doi: 10.1016/j.jacep.2015.09.013. Epub 2015 Oct 24.
This paper reviews the contribution of autonomic nervous system (ANS) modulation in the treatment of arrhythmias. Both the atria and ventricles are innervated by an extensive network of nerve fibers of parasympathetic and sympathetic origin. Both the parasympathetic and sympathetic nervous system exert arrhythmogenic electrophysiological effects on atrial and pulmonary vein myocardium, while in the ventricle the sympathetic nervous system plays a more dominant role in arrhythmogenesis. Identification of ANS activity is possible with nuclear imaging. This technique may provide further insight in mechanisms and treatment targets. Additionally, the myocardial effects of the intrinsic ANS can be identified through stimulation of the ganglionic plexuses. These can be ablated for the treatment of atrial fibrillation. New (non-) invasive treatment options targeting the extrinsic cardiac ANS, such as low-level tragus stimulation and renal denervation, provide interesting future treatment possibilities both for atrial fibrillation and ventricular arrhythmias. However, the first randomized trials have yet to be performed. Future clinical studies on modifying the ANS may not only improve the outcome of ablation therapy but may also advance our understanding of the manner in which the ANS interacts with the myocardium to modify arrhythmogenic triggers and substrate.
本文综述了自主神经系统（ANS）调节在心律失常治疗中的作用。心房和心室均由广泛的副交感神经和交感神经起源的神经纤维网络支配。副交感神经系统和交感神经系统均对心房和肺静脉心肌产生致心律失常的电生理效应，而在心室中，交感神经系统在心律失常发生中起更主导的作用。通过核成像可以识别ANS活动。这项技术可能会进一步深入了解机制和治疗靶点。此外，通过刺激神经节丛可以识别内源性ANS的心肌效应。这些神经节丛可以被消融以治疗心房颤动。针对心脏外ANS的新的（非）侵入性治疗选择，如低水平耳屏刺激和肾去神经支配，为心房颤动和室性心律失常提供了有趣的未来治疗可能性。然而，首批随机试验尚未进行。未来关于调节ANS的临床研究不仅可能改善消融治疗的结果，还可能推进我们对ANS与心肌相互作用以改变致心律失常触发因素和基质方式的理解。
