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.
Keywords: AERP, atrial effective refractory period; AF, atrial fibrillation; AGP, autonomic ganglionic plexus; ANS, autonomic nervous system; CABG, coronary artery bypass grafting; HRV, heart rate variability; ICD, implantable cardioverter-defibrillator; LLVNS, low-level vagal nerve stimulation; OSA, obstructive sleep apnea; POAF, post-operative atrial fibrillation; PVI, pulmonary vein isolation; RDN, renal denervation; SCS, spinal cord stimulation; SGB, stellate ganglion blockade; SNS, sympathetic nervous system; VF, ventricular fibrillation; VNS, vagal nerve stimulation; VT, ventricular tachycardia; arrhythmia; atrial fibrillation; autonomic nervous system; ganglionated plexi; neuromodulation; ventricular arrhythmias.