Cardiac Neuromodulation and Neurocardiology

Neurocardiology has mostly been a specialty of medicine led by anatomists and physiologists. The characterization of the cardiac autonomic nervous system has resulted in a new understanding and appreciation of neurocardiology, leading to potential novel neuromodulation therapies in clinical cardiology and cardiac electrophysiology. Sympathectomy or spinal cord stimulation for the treatment of angina pectoris, as well as cardiac sympathetic denervation for the treatment of long QT syndrome associated with malignant ventricular arrhythmias, have been available and performed for more than half a century. However, a new neuromodulation has emerged, based on contemporary research findings, assisted by state-of-the art imaging and ablation techniques. Patients with structural heart disease and malignant ventricular arrhythmias, as well as symptomatic ventricular ectopy, can potentially benefit from techniques to reduce autonomic tone, such as stellate ganglionic block, epidural anesthesia and cardiac sympathetic denervation. Renal sympathetic denervation not only has been shown to ameliorate the treatment of patients with hypertension, but may also reduce atrial and ventricular arrhythmias. Patients with heart failure may be improved clinically by potentiating parasympathetic tone. Cardiac mapping of ganglia and nerves can be performed to delineate regions of ablation that can suppress atrial fibrillation, and potentially treat symptomatic bradyarrhythmias and cardio-inhibitory syncope.