Fedele Laura, Brand Thomas
Developmental Dynamics, National Heart and Lung Institute (NHLI), Imperial College, London W12 0NN, UK.
J Cardiovasc Dev Dis. 2020 Nov 24;7(4):54. doi: 10.3390/jcdd7040054.
The cardiac autonomic nervous system (CANS) plays a key role for the regulation of cardiac activity with its dysregulation being involved in various heart diseases, such as cardiac arrhythmias. The CANS comprises the extrinsic and intrinsic innervation of the heart. The intrinsic cardiac nervous system (ICNS) includes the network of the intracardiac ganglia and interconnecting neurons. The cardiac ganglia contribute to the tight modulation of cardiac electrophysiology, working as a local hub integrating the inputs of the extrinsic innervation and the ICNS. A better understanding of the role of the ICNS for the modulation of the cardiac conduction system will be crucial for targeted therapies of various arrhythmias. We describe the embryonic development, anatomy, and physiology of the ICNS. By correlating the topography of the intracardiac neurons with what is known regarding their biophysical and neurochemical properties, we outline their physiological role in the control of pacemaker activity of the sinoatrial and atrioventricular nodes. We conclude by highlighting cardiac disorders with a putative involvement of the ICNS and outline open questions that need to be addressed in order to better understand the physiology and pathophysiology of the ICNS.
心脏自主神经系统（CANS）在心脏活动调节中起关键作用，其调节异常与多种心脏病有关，如心律失常。CANS包括心脏的外在和内在神经支配。心脏内在神经系统（ICNS）包括心内神经节和相互连接的神经元网络。心脏神经节有助于对心脏电生理进行紧密调节，作为整合外在神经支配和ICNS输入的局部枢纽。更好地理解ICNS在调节心脏传导系统中的作用对于各种心律失常的靶向治疗至关重要。我们描述了ICNS的胚胎发育、解剖结构和生理学。通过将心内神经元的拓扑结构与其已知的生物物理和神经化学特性相关联，我们概述了它们在控制窦房结和房室结起搏活动中的生理作用。最后，我们强调了可能涉及ICNS的心脏疾病，并概述了为更好地理解ICNS的生理学和病理生理学需要解决的开放性问题。
