title: The role of the autonomic nervous system in arrhythmias and sudden cardiac death.
abstract: The autonomic nervous system (ANS) is complex and plays an important role in cardiac arrhythmia pathogenesis. A deeper understanding of the anatomy and development of the ANS has shed light on its involvement in cardiac arrhythmias. Alterations in levels of Sema-3a and NGF, both growth factors involved in innervation patterning during development of the ANS, leads to cardiac arrhythmias. Dysregulation of the ANS, including polymorphisms in genes involved in ANS development, have been implicated in sudden infant death syndrome. Disruptions in the sympathetic and/or parasympathetic systems of the ANS can lead to cardiac arrhythmias and can vary depending on the type of arrhythmia. Simultaneous stimulation of both the sympathetic and parasympathetic systems is thought to lead to atrial fibrillation whereas increased sympathetic stimulation is thought to lead to ventricular fibrillation or ventricular tachycardia. In inherited arrhythmia syndromes, such as Long QT and Catecholaminergic Polymorphic Ventricular Tachycardia, sympathetic system stimulation is thought to lead to ventricular tachycardia, subsequent arrhythmias, and in severe cases, cardiac death. On the other hand, arrhythmic events in Brugada Syndrome have been associated with periods of high parasympathetic tone. Increasing evidence suggests that modulation of the ANS as a therapeutic strategy in the treatment of cardiac arrhythmias is safe and effective. Further studies investigating the involvement of the ANS in arrhythmia pathogenesis and its modulation for the treatment of cardiac arrhythmias is warranted.
authors.affiliation: Department of Pediatrics, University of British Columbia, BC Children's Hospital Heart Center, Room 1F9, 4480 Oak Street, V6H 3V4 Vancouver, BC, Canada.
authors.forename: Sonia
authors.initials: S
authors.lastname: Franciosi
authors.affiliation: Department of Pediatrics, University of British Columbia, BC Children's Hospital Heart Center, Room 1F9, 4480 Oak Street, V6H 3V4 Vancouver, BC, Canada.
authors.forename: Frances K G
authors.initials: FKG
authors.lastname: Perry
authors.affiliation: Department of Pediatrics, University of British Columbia, BC Children's Hospital Heart Center, Room 1F9, 4480 Oak Street, V6H 3V4 Vancouver, BC, Canada.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Roston
authors.affiliation: Department of Pediatrics, University of British Columbia, BC Children's Hospital Heart Center, Room 1F9, 4480 Oak Street, V6H 3V4 Vancouver, BC, Canada.
authors.forename: Kathryn R
authors.initials: KR
authors.lastname: Armstrong
authors.affiliation: Department of Biomedical Physiology and Kinesiology, Faculty of Science, Simon Fraser University, Burnaby, BC V5A 1S6, Canada.
authors.forename: Victoria E
authors.initials: VE
authors.lastname: Claydon
authors.affiliation: Department of Pediatrics, University of British Columbia, BC Children's Hospital Heart Center, Room 1F9, 4480 Oak Street, V6H 3V4 Vancouver, BC, Canada. Electronic address: ssanatani@cw.bc.ca.
authors.forename: Shubhayan
authors.initials: S
authors.lastname: Sanatani
mesh_terms: D000818:Animals; D001145:Arrhythmias, Cardiac / Q000503:physiopathology* / Q000628:therapy; D001341:Autonomic Nervous System / Q000503:physiopathology*; D016757:Death, Sudden, Cardiac / Q000209:etiology; D006801:Humans; D007223:Infant; D013398:Sudden Infant Death / Q000209:etiology
keywords: Arrhythmias; Autonomic nervous system; Neurocardiology; Neuromodulation; Sudden cardiac death; Sudden infant death syndrome