Burdon Sanderson Cardiac Science Centre, Department of Physiology, Anatomy and Genetics, University of Oxford, Oxford, UK.
Oxford University Hospital NHS Foundation Trust, Oxford Heart Centre, John Radcliffe Hospital, Oxford, UK.
Nat Rev Cardiol. 2019 Dec;16(12):707-726. doi: 10.1038/s41569-019-0221-2. Epub 2019 Jun 13.
Research into cardiac autonomic control has received great interest in the past 20 years, and we are now at a critical juncture with regard to the clinical translation of the experimental findings. A rush to develop clinical interventions and implant a range of devices aimed at cardiac neuromodulation therapy has occurred. This interest has been driven by research, superimposed on commercial opportunities and perhaps the more relaxed regulatory framework governing implantable devices and interventions compared with that for pharmacotherapy. However, many of the results of the clinical trials into these therapies have been disappointing or conflicting. This lack of positive results is partly attributable to a scramble to find simple solutions for complex problems that we do not yet fully understand. Are there reasons to be optimistic? In this Review, we highlight areas in the field of cardiac autonomic control that we feel show the most promise for clinical translation and areas in which our current range of blunt tools need to be refined to bring about long-term success in treating arrhythmias.
在过去的 20 年里，心脏自主控制的研究受到了极大的关注，我们现在正处于将实验发现转化为临床应用的关键时刻。人们急于开发旨在进行心脏神经调节治疗的临床干预措施和植入一系列设备。这种兴趣是由研究驱动的，叠加在商业机会上，也许与药物治疗相比，可植入设备和干预措施的监管框架更为宽松。然而，这些疗法的临床试验结果令人失望或相互矛盾。这种缺乏积极结果的情况部分归因于急于寻找我们尚未完全理解的复杂问题的简单解决方案。有理由感到乐观吗？在这篇综述中，我们强调了心脏自主控制领域中我们认为最有希望进行临床转化的领域，以及我们目前的一系列钝性工具需要改进的领域，以在治疗心律失常方面取得长期成功。
