EP Fellows Curriculum: Autonomic Modulation of Ventricular Arrhythmias-EP Fellows Curriculum: Autonomic Modulation of Ventricular Arrhythmias

Video Transcription

Video Summary

In this presentation, the speaker discusses the pathophysiology and various therapies for autonomic modulation of ventricular arrhythmias. The focus is on the sympathetic nervous system, but there are also promising therapies for parasympathetic modulation. The speaker explains that there are parasympathetic, sympathetic, and afferent nerve fibers surrounding the heart that play a role in cardiac function. The sympathetic nervous system innervates the heart through the stellate and middle cervical ganglia, and the fibres release norepinephrine, which can affect heart rate and action potential duration. In patients with cardiac injury, there can be denervation and subsequent reinnervation of the myocardium, leading to heterogeneity in sympathetic activation and an increased risk of ventricular arrhythmias. The speaker discusses several neuromodulatory therapies, including thoracic epidural anesthesia, stellate ganglion blockade, cardiac sympathetic denervation (CSD), and renal denervation. CSD has shown promising results in reducing ventricular arrhythmias and shocks in patients with refractory ventricular tachycardia. Renal denervation has also shown potential in reducing ventricular arrhythmia episodes. The speaker emphasizes the need to target the autonomic nervous system at different levels to achieve optimal control of ventricular arrhythmias.

Keywords

autonomic modulation

ventricular arrhythmias

sympathetic nervous system

parasympathetic modulation

nerve fibers

cardiac function

denervation

neuromodulatory therapies

renal denervation