Prairie Heart Institute, HSHS St. John's Hospital, 619 E Mason St, 62701, Springfield, IL, USA.
Herzschrittmacherther Elektrophysiol. 2021 Sep;32(3):295-301. doi: 10.1007/s00399-021-00776-1. Epub 2021 Aug 13.
In recent decades, numerous anatomical and physiological studies of the cardiac autonomic nervous system (ANS) have investigated the complex relationships between the brain and the heart. Autonomic activation not only alters heart rate, conduction, and hemodynamics, but also cellular and subcellular properties of individual myocytes. Moreover, the cardiac ANS plays an essential role in cardiac arrhythmogenesis. There is mounting evidence that neural modulation either by ablation or stimulation can effectively control a wide spectrum of cardiac arrhythmias. This article discusses anatomic aspects of the cardiac ANS, focusing on how autonomic activities influence cardiac electrophysiology. Specific autonomic triggers of various cardiac arrhythmias, in particular atrial fibrillation (AF) and ventricular arrhythmias, are also briefly discussed. Studies with heart-rate variability analysis indicate that, rather than being triggered by either vagal or sympathetic activity, the onset of AF can be associated with simultaneous discharge of both limbs, leading to an imbalance between these two arms of the cardiac ANS. At the same time, sudden cardiac death resulting from ventricular arrhythmias continues to be a significant health and societal burden. These nerve activities of the cardiac ANS can be targeted for the treatment for cardiac arrhythmias, in particular AF and ventricular tachyarrhythmias.
近几十年来，大量关于心脏自主神经系统（ANS）的解剖和生理学研究已经探究了大脑和心脏之间复杂的关系。自主激活不仅改变心率、传导和血液动力学，还改变单个心肌细胞的细胞和亚细胞特性。此外，心脏自主神经系统在心律失常的发生中起着至关重要的作用。越来越多的证据表明，通过消融或刺激进行神经调节可以有效地控制广泛的心律失常。本文讨论了心脏自主神经系统的解剖学方面，重点关注自主活动如何影响心脏电生理学。还简要讨论了各种心律失常（特别是心房颤动（AF）和室性心律失常）的特定自主触发因素。心率变异性分析研究表明，AF 的发作不是由迷走神经或交感神经活动引发的，而是可能与两者同时放电有关，导致心脏自主神经系统的这两个分支之间失衡。同时，由于室性心律失常导致的心脏性猝死仍然是一个重大的健康和社会负担。这些心脏自主神经系统的神经活动可以作为治疗心律失常，特别是心房颤动和室性心动过速的靶点。
