Author + information
- Received December 31, 2018
- Revision received February 22, 2019
- Accepted February 22, 2019
- Published online August 26, 2019.
- Nathan H. Waldron, MD, MHSa,b,∗,
- Marat Fudim, MDb,c,∗,
- Joseph P. Mathew, MD, MHS, MBAa,b and
- Jonathan P. Piccini, MD, MHSb,c,∗ ()
- aDepartment of Anesthesia, Duke University Medical Center, Durham, North Carolina
- bDuke Clinical Research Institute, Durham, North Carolina
- cElectrophysiology Section, Duke University Medical Center, Durham, North Carolina
- ↵∗Address for correspondence:
Dr. Jonathan P. Piccini, Electrophysiology Section, Duke University Medical Center, Duke Clinical Research Institute, PO Box 17969, Durham, North Carolina 27710.
• Derangement of autonomic nervous signaling is an important contributor to cardiac arrhythmogenesis.
• Modulation of autonomic nervous signaling holds significant promise for the prevention and treatment of cardiac arrhythmias.
• Further clinical investigation is necessary to establish the efficacy and safety of autonomic modulatory therapies in reducing cardiac arrhythmias.
There is an increasing recognition of the importance of interactions between the heart and the autonomic nervous system in the pathophysiology of arrhythmias. These interactions play a role in both the initiation and maintenance of arrhythmias and are important in both atrial and ventricular arrhythmia. Given the importance of the autonomic nervous system in the pathophysiology of arrhythmias, there has been notable effort in the field to improve existing therapies and pioneer additional interventions directed at cardiac-autonomic targets. The interventions are targeted to multiple and different anatomic targets across the neurocardiac axis. The purpose of this review is to provide an overview of the rationale for neuromodulation in the treatment of arrhythmias and to review the specific treatments under evaluation and development for the treatment of both atrial fibrillation and ventricular arrhythmias.
- atrial fibrillation
- autonomic nervous system
- ganglionated plexi
- ventricular arrhythmias
↵∗ Drs. Waldron and Fudim contributed equally to this work and are joint first authors.
Dr. Waldron has received personal fees and grants from Allergan, and AHA grant 16MCPRP30700010 and the NIGMS T32 postdoctoral training grant T32GM008600. Dr. Fudim has received grants from AHA grant 17MCPRP33460225 and NIH T32 grant 5T32HL007101; and has received personal fees from Galvani, Coridea, and Axon Therapies. Dr. Mathew is on the Board of Directors and owns equity in MedBlue Data; and has received grants from NIH R01 grant number HL130443. Dr. Piccini has received grants for clinical research from Abbott, the American Heart Association, Boston Scientific, Gilead, Janssen Pharmaceuticals, and the NHLBI; and serves as a consultant to Abbott, Allergan, ARCA Biopharma, Biotronik, Boston Scientific, Johnson & Johnson, LivaNova, Medtronic, Milestone, Oliver Wyman Health, Sanofi, Philips, and Up-to-Date.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Basic to Translational Science author instructions page.
- Received December 31, 2018.
- Revision received February 22, 2019.
- Accepted February 22, 2019.
- 2019 The Authors