NEUROGENIC CARDIAC ARRHYTHMIAS – THE ROLE OF THE AUTONOMIC NERVOUS SYSTEM

This work explores the contribuons of the autonomic nervous system (ANS) to cardiac arrhythmias, with parcular focus on the impact of autonomic imbalance as a trigger for pathological arrhythmia development.Although the ANS is widely regarded as a regulatory system that maintains cardiovascular stability, growing evidence suggests that ANS overacvity or dysfuncon plays an important role in arrhythmogenesis.This paper describes the mechanism by which excessive sympathec acvity promotes ventricular arrhythmias and sudden cardiac death, parcularly in paents with structural heart disease or post viral illness (such as .While overall protec-ve, excessive vagal eects may be arrhythmogenic, especially in the cases of vagally mediated atrial brillaon and neurocardiogenic syncope.Parcular focus is placed on the intrinsic cardiac nervous system (ICNS) -a network located within the heart that can modulate rhythm independently.Upon stress, ischemia, or inammaon, this system remodels, generang arrhythmia-favoring microenvironments.In addion, it addresses the potenal role of neurotransmiers -like norepinephrine, acetylcholine and neuropepde Y -and the eect on cardiac excitability of immune signals and glial cells.We also review therapeuc strategies aimed at autonomic modulaon.These range from classical pharmacological approaches (e.g., beta-blockers) to novel neuromodulaon therapies (e.g., vagus nerve smulaon, stellate ganglion block) and experimental non-invasive approaches (e.g., transcutaneous vagal smulaon).ANS modulates arrhythmic forces as well as all stabilizing forces therefore allowing it to be pro-arrhythmic and an-arrhythmic, depending on the framework.Knowledge of this dual role is crical for beer, more tailored prevenon and treatment of cardiac arrhythmias.