Autonomic Tone and Cardiac Arrhythmias: Insight Into Therapeutic Approach

The autonomic nerve system innervates cardiac tissues and its conduction system. It plays an important role in the initiation and maintenance of both atrial and ventricular arrhythmias. A network of sympathetic and parasympathetic nerves is anatomically divided into extrinsic and intrinsic portions. Both of them are targets of therapeutic approach for neuromodulation through antagonistic and/or agonistic interventions. For example, ganglionated plexi ablation, cardiac sympathetic denervation, renal sympathetic denervation and vagal nerve (tragus) stimulation have been reported to be effective in controlling atrial and ventricular arrhythmias. More recently, skin sympathetic nerve recording and subcutaneous nerve stimulation have been shown in animal models to serve as less invasive methods for neural recording and neuromodulation. These promising techniques may improve the care of patients with cardiac arrhythmias. However, several questions have to be answered prior to applying neuromodulation methods in actual clinical practice. What disease conditions can best be managed by neuromodulation methods? What is the limit of the beneficial effects? What are the differences between acute and chronic effects? What are the complications and side effects? How long does the benefits of neuromodulation persist? Further research in neuromodulation is clearly needed. This symposium focuses on the state-of-art of the neuromodulation for cardiac arrhythmias and heart failure therapies. The experts in the field will discuss the mechanisms of neuromodulation and the experimental/clinical studies related to the effects and side effects of neuromodulation. We expect that these discussions will be highly informative for clinicians and scientists interested in cardiac arrhythmias.