University of California, Los Angeles (UCLA) Cardiac Arrhythmia Center and Neurocardiology Research Program of Excellence, David Geffen School of Medicine, UCLA, Los Angeles, California.
University of California, Los Angeles (UCLA) Cardiac Arrhythmia Center and Neurocardiology Research Program of Excellence, David Geffen School of Medicine, UCLA, Los Angeles, California.
JACC Clin Electrophysiol. 2019 Aug;5(8):881-896. doi: 10.1016/j.jacep.2019.06.009. Epub 2019 Aug 19.
Autonomic dysregulation in cardiovascular disease plays a major role in the pathogenesis of arrhythmias. Cardiac neural control relies on complex feedback loops consisting of efferent and afferent limbs, which carry sympathetic and parasympathetic signals from the brain to the heart and sensory signals from the heart to the brain. Cardiac disease leads to neural remodeling and sympathovagal imbalances with arrhythmogenic effects. Preclinical studies of modulation at central and peripheral levels of the cardiac autonomic nervous system have yielded promising results, leading to early stage clinical studies of these techniques in atrial fibrillation and refractory ventricular arrhythmias, particularly in patients with inherited primary arrhythmia syndromes and structural heart disease. However, significant knowledge gaps in basic cardiac neurophysiology limit the success of these neuromodulatory therapies. This review discusses the recent advances in neuromodulation for cardiac arrhythmia management, with a clinical scenario-based approach aimed at bringing neurocardiology closer to the realm of the clinical electrophysiologist.
自主神经功能紊乱在心血管疾病的发病机制中起主要作用。心脏的神经控制依赖于复杂的反馈回路，包括传出和传入支，它们将来自大脑的交感和副交感信号传递到心脏，并将来自心脏的感觉信号传递到大脑。心脏疾病导致神经重塑和交感神经与副交感神经失衡，从而产生心律失常效应。心脏自主神经系统中枢和外周水平调节的临床前研究取得了有希望的结果，导致这些技术在心房颤动和难治性室性心律失常中的早期临床研究，特别是在遗传性原发性心律失常综合征和结构性心脏病患者中。然而，基础心脏神经生理学中的重大知识空白限制了这些神经调节疗法的成功。这篇综述讨论了心脏心律失常管理中神经调节的最新进展，采用基于临床情况的方法，旨在使心脏神经科更接近临床电生理学家的领域。
