Author + information
- Received March 18, 2015
- Revision received April 17, 2015
- Accepted May 1, 2015
- Published online October 1, 2015.
- ∗Cardiology Division, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- †Cardiac Arrhythmia Service, Department of Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
- ↵∗Reprint requests and correspondence:
Dr. Jagmeet P. Singh, Cardiac Arrhythmia Service, Massachusetts General Hospital, Harvard Medical School, 55 Fruit Street, Boston, Massachusetts 02114.
Heart failure (HF) represents a significant and expanding public health burden associated with increasing prevalence and exponential growth in related health care costs. Contemporary advances in both pharmacological and nonpharmacological therapies have often been restricted in application and benefit. Given the critical role of the autonomic nervous system (ANS) in maintaining cardiovascular homeostasis in the failing heart, there has been increasing interest in the role of ANS modulation as a therapeutic modality in HF. In this review, we highlight the anatomy of the ANS and its role in the pathophysiology of HF, as well as metrics of its assessment. Given the limitations associated with pharmacological ANS modulation, including lack of specificity and medication intolerance, we focus in this review on contemporary nonpharmacological ANS modulation therapies. For each therapy—vagal nerve stimulation, carotid baroreceptor stimulation, spinal cord stimulation, and renal denervation—we review the rationale for modulation, pre-clinical and clinical assessments, as well as procedural considerations and limitations. We conclude by commenting on novel technologies and strategies for ANS modulation on the horizon.
Dr. Singh has received research grants from Boston Scientific, St. Jude Medical, Medtronic, and Sorin Group; and has been a consultant for Boston Scientific, St. Jude Medical, Medtronic, Sorin Group, CardioInsight, and Respicardia. Dr. Chatterjee has reported that he has no relationships relevant to the contents of this paper to disclose.
- Received March 18, 2015.
- Revision received April 17, 2015.
- Accepted May 1, 2015.
- American College of Cardiology Foundation