Effects of renal denervation on the development of post-myocardial infarction heart failure and cardiac autonomic nervous system in rats

Alterations in resting autonomic tone can be pathogenic in many cardiovascular disease states, such as heart failure and hypertension. Indeed, autonomic modulation by way of beta-blockade is a standard treatment of these conditions. There is a significant interest in developing non-pharmacological methods of autonomic modulation as well. For instance, clinical trials of vagal stimulation and spinal cord stimulation in the treatment of heart failure are currently underway, and renal denervation has been studied recently in the treatment of resistant hypertension. Notably, autonomic stimulation is also a potent modulator of cardiac electrophysiology. Manipulating the autonomic nervous system in studies designed to treat heart failure and hypertension have revealed that autonomic modulation may have a role in the treatment of common atrial and ventricular arrhythmias as well. Experimental data on vagal nerve and spinal cord stimulation suggest that each technique may reduce ventricular arrhythmias. Similarly, renal denervation may play a role in the treatment of atrial fibrillation, as well as in controlling refractory ventricular arrhythmias. In this review, we present the current experimental and clinical data on the effect of these therapeutic modalities on cardiac electrophysiology and their potential role in arrhythmia management.

Download Full-text

GW25-e0589 A comparison of the efficacy of renal denervation and pharmacologic therapies in post-myocardial infarction heart failure

Journal of the American College of Cardiology ◽

10.1016/j.jacc.2014.06.379 ◽

2014 ◽

Vol 64 (16) ◽

pp. C81-C82

Author(s):

Hu Jialu ◽

Hou Yuemei ◽

Ge Junbo

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Renal Denervation ◽

Post Myocardial Infarction ◽

Infarction Heart ◽

Pharmacologic Therapies

Download Full-text

Autonomic nervous system drugs

ESC CardioMed ◽

10.1093/med/9780198784906.003.0033 ◽

2018 ◽

pp. 173-180

Author(s):

Atul Pathak

Keyword(s):

Myocardial Infarction ◽

Heart Failure ◽

Nervous System ◽

Autonomic Nervous System ◽

Beta Blockers ◽

Myocardial Infarctions ◽

Alpha Blockers ◽

Heart Failure Patients ◽

Autonomic Nervous ◽

Clinical Syndromes

Drugs able to modulate the autonomic nervous system have improved the outcome of many cardiovascular and non-cardiovascular conditions. In particular, heart failure, post-myocardial infarction, and hypertension are the cardiovascular clinical syndromes in which autonomic nervous system inhibition or stimulation has modified patient outcomes. While in heart failure and post-myocardial infarctions beta blockers have become a cornerstone therapy by improvement of morbidity and mortality, their use in hypertension has been progressively limited. The same is true for other drugs modulating the autonomic nervous system such as alpha blockers, used only in patients with difficult to control hypertension and not in heart failure patients, in whom this class of drugs exacerbates heart failure in clinical trials. This chapter aims to provide an appraisal of drugs modulating the autonomic nervous system with descriptions of their mechanism(s) of action, pharmacokinetics, adverse effects, and drug interactions.

Download Full-text