Year: 2025
Type: article
Abstract: This work explores the contribu琀椀ons of the autonomic nervous system (ANS) to cardiac arrhythmias, with par琀椀cular focus on the impact of autonomic imbalance as a trigger for pathological arrhythmia development.Although the ANS is widely regarded as a regulatory system that maintains cardiovascular stability, growing evidence suggests that ANS overac琀椀vity or dysfunc琀椀on plays an important role in arrhythmogenesis.This paper describes the mechanism by which excessive sympathe琀椀c ac琀椀vity promotes ventricular arrhythmias and sudden cardiac death, par琀椀cularly in pa琀椀ents with structural heart disease or post viral illness (such as COVID-19).While overall protec-琀椀ve, excessive vagal e昀昀ects may be arrhythmogenic, especially in the cases of vagally mediated atrial 昀椀brilla琀椀on and neurocardiogenic syncope.Par琀椀cular focus is placed on the intrinsic cardiac nervous system (ICNS) -a network located within the heart that can modulate rhythm independently.Upon stress, ischemia, or in昀氀amma琀椀on, this system remodels, genera琀椀ng arrhythmia-favoring microenvironments.In addi琀椀on, it addresses the poten琀椀al role of neurotransmi琀琀ers -like norepinephrine, acetylcholine and neuropep琀椀de Y -and the e昀昀ect on cardiac excitability of immune signals and glial cells.We also review therapeu琀椀c strategies aimed at autonomic modula琀椀on.These range from classical pharmacological approaches (e.g., beta-blockers) to novel neuromodula琀椀on therapies (e.g., vagus nerve s琀椀mula琀椀on, stellate ganglion block) and experimental non-invasive approaches (e.g., transcutaneous vagal s琀椀mula琀椀on).ANS modulates arrhythmic forces as well as all stabilizing forces therefore allowing it to be pro-arrhythmic and an琀椀-arrhythmic, depending on the framework.Knowledge of this dual role is cri琀椀cal for be琀琀er, more tailored preven琀椀on and treatment of cardiac arrhythmias.
Authors: S. S. Tkachenko, O. G. Rodynskyi, M. O. Horova
Institution: Dnipro State Medical University
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W4412454642