Sympathetic Activation and Arrhythmogenesis after Myocardial Infarction: Where Do We Stand?

Autor: Konstantinos C. Zekios, Eleni-Taxiarchia Mouchtouri, Panagiotis Lekkas, Dimitrios N. Nikas, Theofilos M. Kolettis
Jazyk: angličtina
Rok vydání: 2021
Předmět:
Zdroj: Journal of Cardiovascular Development and Disease, Vol 8, Iss 5, p 57 (2021)
Druh dokumentu: article
ISSN: 2308-3425
DOI: 10.3390/jcdd8050057
Popis: Myocardial infarction often leads to progressive structural and electrophysiologic remodeling of the left ventricle. Despite the widespread use of β-adrenergic blockade and implantable defibrillators, morbidity and mortality from chronic-phase ventricular tachyarrhythmias remains high, calling for further investigation on the underlying pathophysiology. Histological and functional studies have demonstrated extensive alterations of sympathetic nerve endings at the peri-infarct area and flow-innervation mismatches that create a highly arrhythmogenic milieu. Such accumulated evidence, along with the previously well-documented autonomic dysfunction as an important contributing factor, has stirred intense research interest for pharmacologic and non-pharmacologic neuromodulation in post-infarction heart failure. In this regard, aldosterone inhibitors, sacubitril/valsartan and sodium-glucose cotransporter type 2 inhibitors have shown antiarrhythmic effects. Non-pharmacologic modalities, currently tested in pre-clinical and clinical trials, include transcutaneous vagal stimulation, stellate ganglion modulation and renal sympathetic denervation. In this review, we provide insights on the pathophysiology of ventricular arrhythmogenesis post-myocardial infarction, focusing on sympathetic activation.
Databáze: Directory of Open Access Journals