Tkachenko S. S., Rodynskyi O. G., Horova M. O.

NEUROGENIC CARDIAC ARRHYTHMIAS – THE ROLE OF THE AUTONOMIC NERVOUS SYSTEM

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Tkachenko S. S., Rodynskyi O. G., Horova M. O.

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LITERATURE REVIEWS

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Scientific article

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This work explores the contributions of the autonomic nervous system (ANS) to cardiac arrhythmias, with partic- ular 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 sug- gests that ANS overactivity or dysfunction plays an important role in arrhythmogenesis. This paper describes the mechanism by which excessive sympathetic activity promotes ventricular arrhythmias and sudden cardiac death, particularly in patients with structural heart disease or post viral illness (such as COVID-19). While overall protec- tive, excessive vagal effects may be arrhythmogenic, especially in the cases of vagally mediated atrial fibrillation and neurocardiogenic syncope. Particular 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 inflammation, this system remodels, generating arrhythmia-favoring microenvironments. In addition, it addresses the potential role of neurotransmitters – like norepinephrine, acetylcholine and neuropeptide Y – and the effect on cardiac excitability of immune signals and glial cells. We also review therapeutic strategies aimed at autonomic modulation. These range from classical pharmacological approaches (e.g., beta-blockers) to novel neuromodulation therapies (e.g., vagus nerve stimulation, stellate ganglion block) and experimental non-invasive approaches (e.g., transcutaneous vagal stimulation). ANS modulates arrhythmic forces as well as all stabilizing forces therefore allowing it to be pro-ar- rhythmic and anti-arrhythmic, depending on the framework. Knowledge of this dual role is critical for better, more tailored prevention and treatment of cardiac arrhythmias.

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Bibliography:

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Publication of the article:

«Bulletin of problems biology and medicine», Issue 2,177, 112-121 pages, index UDC 612.83:612.662.9:618.173-073.7/-076-085:615.2.1-092.9

DOI:

10.29254/2077-4214-2025-2-177-112-121