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Neuromodulation for Ventricular Tachycardia and Atrial Fibrillation: A Clinical Scenario-Based Review.
JACC Clin Electrophysiol 2019; 5(8):881-896JC

Abstract

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.

Authors+Show Affiliations

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.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. Electronic address: kshivkumar@mednet.ucla.edu.

Pub Type(s)

Journal Article
Review

Language

eng

PubMed ID

31439288

Citation

Zhu, Ching, et al. "Neuromodulation for Ventricular Tachycardia and Atrial Fibrillation: a Clinical Scenario-Based Review." JACC. Clinical Electrophysiology, vol. 5, no. 8, 2019, pp. 881-896.
Zhu C, Hanna P, Rajendran PS, et al. Neuromodulation for Ventricular Tachycardia and Atrial Fibrillation: A Clinical Scenario-Based Review. JACC Clin Electrophysiol. 2019;5(8):881-896.
Zhu, C., Hanna, P., Rajendran, P. S., & Shivkumar, K. (2019). Neuromodulation for Ventricular Tachycardia and Atrial Fibrillation: A Clinical Scenario-Based Review. JACC. Clinical Electrophysiology, 5(8), pp. 881-896. doi:10.1016/j.jacep.2019.06.009.
Zhu C, et al. Neuromodulation for Ventricular Tachycardia and Atrial Fibrillation: a Clinical Scenario-Based Review. JACC Clin Electrophysiol. 2019;5(8):881-896. PubMed PMID: 31439288.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Neuromodulation for Ventricular Tachycardia and Atrial Fibrillation: A Clinical Scenario-Based Review. AU - Zhu,Ching, AU - Hanna,Peter, AU - Rajendran,Pradeep S, AU - Shivkumar,Kalyanam, Y1 - 2019/08/19/ PY - 2019/03/27/received PY - 2019/05/30/revised PY - 2019/06/04/accepted PY - 2020/08/19/pmc-release PY - 2019/8/24/entrez PY - 2019/8/24/pubmed PY - 2019/8/24/medline KW - cardiac autonomic nervous system KW - cardiac ganglionated plexi KW - cardiac sympathetic denervation KW - neuromodulation KW - stellate ganglion KW - vagal nerve stimulation SP - 881 EP - 896 JF - JACC. Clinical electrophysiology JO - JACC Clin Electrophysiol VL - 5 IS - 8 N2 - 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. SN - 2405-5018 UR - https://www.unboundmedicine.com/medline/citation/31439288/Neuromodulation_for_Ventricular_Tachycardia_and_Atrial_Fibrillation:_A_Clinical_Scenario-Based_Review L2 - https://linkinghub.elsevier.com/retrieve/pii/S2405-500X(19)30419-0 DB - PRIME DP - Unbound Medicine ER -