Pahuja Mohit, Akhtar Khawaja Hassan, Krishan Satyam, Nasir Yusra Minahil, Généreux Philippe, Stavrakis Stavros, Dasari Tarun W
Department of Medicine, Section of Cardiovascular Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
Department of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma.
J Soc Cardiovasc Angiogr Interv. 2023 Dec 4;2(6Part B):101199. doi: 10.1016/j.jscai.2023.101199. eCollection 2023 Nov-Dec.
Heart failure (HF) continues to impact the population globally with increasing prevalence. While the pathophysiology of HF is quite complex, the dysregulation of the autonomic nervous system, as evident in heightened sympathetic activity, serves as an attractive pathophysiological target for newer therapies and HF. The degree of neurohormonal activation has been found to correlate to the severity of symptoms, decline in functional capacity, and mortality. Neuromodulation of the autonomic nervous system aims to restore the balance between sympathetic nervous system and the parasympathetic nervous system. Given that autonomic dysregulation plays a major role in the development and progression of HF, restoring this balance may potentially have an impact on the core pathophysiological mechanisms and various HF syndromes. Autonomic modulation has been proposed as a potential therapeutic strategy aimed at reduction of systemic inflammation. Such therapies, complementary to drug and device-based therapies may lead to improved patient outcomes and reduce disease burden. Most professional societies currently do not provide a clear recommendation on the use of neuromodulation techniques in HF. These include direct and indirect vagal nerve stimulation, spinal cord stimulation, baroreflex activation therapy, carotid sinus stimulation, aortic arch stimulation, splanchnic nerve modulation, cardiopulmonary nerve stimulation, and renal sympathetic nerve denervation. In this review, we provide a comprehensive overview of neuromodulation in HF.
心力衰竭（HF）的患病率不断上升，持续影响着全球人口。虽然HF的病理生理学相当复杂，但自主神经系统的失调，如交感神经活动增强所示，是新型治疗方法和HF颇具吸引力的病理生理学靶点。已发现神经激素激活程度与症状严重程度、功能能力下降及死亡率相关。自主神经系统的神经调节旨在恢复交感神经系统和副交感神经系统之间的平衡。鉴于自主神经失调在HF的发生和发展中起主要作用，恢复这种平衡可能会对核心病理生理机制和各种HF综合征产生影响。自主神经调节已被提议作为一种旨在减轻全身炎症的潜在治疗策略。此类疗法与基于药物和器械的疗法相辅相成，可能会改善患者预后并减轻疾病负担。目前大多数专业学会并未就HF中神经调节技术的使用给出明确建议。这些技术包括直接和间接迷走神经刺激、脊髓刺激、压力反射激活疗法、颈动脉窦刺激、主动脉弓刺激、内脏神经调节、心肺神经刺激和肾交感神经去神经支配。在本综述中，我们全面概述了HF中的神经调节。
