Neural Mechanisms of Arrhythmia

  • Hyung-Wook Park
  • Jeong-Gwan Cho


Cardiac autonomic nervous system consists of extrinsic (sympathetic and parasympathetic) and intrinsic (ganglionated plexus concentrated within epicardial fat pads) components. Complex interactions exist between the sympathetic and parasympathetic nervous system on the atrial and ventricular electrophysiologic properties. Disturbed autonomic nervous “balance” of the sympathetic and parasympathetic nerve activity to the heart potentiates the development of arrhythmia. The intrinsic nervous system is thought to be able to function independently and fulfill a number of important interactive and modulatory functions including modulation of arrhythmia substrate. Modulating autonomic tone by ablating or stimulating extrinsic and intrinsic nervous system is emerging as a promising novel therapy in cardiac arrhythmia. Further studies will determine if this new method can be used as an effective means of treating some forms of clinical arrhythmia.


Autonomic Nerve Arrhythmia Mechanism 


  1. 1.
    Armour JA. Potential clinical relevance of the ‘little brain’ on the mammalian heart. Exp Physiol. 2008;93:165–76.PubMedCrossRefGoogle Scholar
  2. 2.
    Cardinal R, Page P, Vermeulen M, et al. Spatially divergent cardiac responses to nicotinic stimulation of ganglionated plexus neurons in the canine heart. Auton Neurosci. 2009;145:55–62.PubMedCrossRefGoogle Scholar
  3. 3.
    Patterson E, Po SS, Scherlag BJ, et al. Triggered firing in pulmonary veins initiated by in vitro autonomic nerve stimulation. Heart Rhythm. 2005;2:624–31.PubMedCrossRefGoogle Scholar
  4. 4.
    Tan AY, Li H, Wachsmann-Hogiu S, et al. Autonomic innervation and segmental muscular disconnections at the human pulmonary vein-atrial junction: implications for catheter ablation of atrial-pulmonary vein junction. J Am Coll Cardiol. 2006;48:132–43.PubMedCrossRefGoogle Scholar
  5. 5.
    Sharifov OF, Fedorov VV, Beloshapko GG, et al. Roles of adrenergic and cholinergic stimulation in spontaneous atrial fibrillation in dogs. J Am Coll Cardiol. 2004;43:483–90.PubMedCrossRefGoogle Scholar
  6. 6.
    Schwartz PJ. Idiopathic long QT syndrome: progress and questions. Am Heart J. 1985;109:399–411.PubMedCrossRefGoogle Scholar
  7. 7.
    Schwartz PJ, Priori SG, Cerrone M, et al. Left cardiac sympathetic denervation in the management of high-risk patients affected by the long-QT syndrome. Circulation. 2004;109:1826–33.PubMedCrossRefGoogle Scholar
  8. 8.
    Nakagawa H, Scherlag BJ, Wu R, et al. Addition of selective ablation of autonomic ganglia to pulmonary vein antrum isolation for treatment of paroxysmal and persistent atrial fibrillation. Circulation. 2006;110, III459.Google Scholar
  9. 9.
    Pappone C, Santinelli V, Manguso F, et al. Pulmonary vein denervation enhances long-term benefit after circumferential ablation for paroxysmal atrial fibrillation. Circulation. 2004;109:327–34.PubMedCrossRefGoogle Scholar
  10. 10.
    Hirose M, Leatmanoratn Z, Laurita KR, et al. Partial vagal denervation increases vulnerability to vagally induced atrial fibrillation. J Cardiovasc Electrophysiol. 2002;13:1272–9. Circulation. 2004;109:1826–33.Google Scholar

Copyright information

© Springer-Verlag London 2014

Authors and Affiliations

  1. 1.Department of Cardiovascular MedicineChonnam National University HospitalGwangjuSouth Korea

Personalised recommendations