About this Research Topic
Cardiovascular Neuromodulation: Mechanisms & Therapies
The autonomic nervous system (ANS) plays a central role in the pathogenesis of several cardiovascular diseases such as:
-Ventricular tachyarrhythmias/fibrillation (VT/VF)
Cardiovascular diseases (CVDs) are the leading cause of death -globally, taking an estimated 17.9 million lives each year ( 31 % of all deaths worldwide ). Mechanisms implicated in the pathophysiology of CVD include autonomic nervous system (ANS) dysfunction, endothelial dysfunction , vasoconstriction, and systemic inflammation.
Today, several therapeutic options are available to treat heart and cardiovascular patients, mainly medical therapies targeting specific pathways in vascular biology and physiology, centered around vasoconstriction, cell proliferation, sympathetic overactivity, defective renin-angiotensin-aldosterone system and ANS imbalance. Those drugs have improved the quality of life and survival of patients. On the other hand, they do not cure the disease and are associated with side effects like dry cough, flushing, peripheral edema, hyperkalemia, hypotension, and reduction of cardiac output. Despite significant advances, CVDs remain a serious, life-threatening condition and new therapeutic modalities must be pursued.
Neuromodulation therapies, which is one of the upsurging fields of modern medicine, involving a wide range of specialties and a variety of disorders. It is the process of stimulation, inhibition, regulation, or therapeutic alterations of the electrical or/and chemical activities, in the central, peripheral, or autonomic nervous systems that can be directed toward reverse/prevent progression of cardiovascular disease, by using implantable or non-implantable medical devices such as pacemakers, neural stimulators or micro-infusion pumps.
Therapies such as stellate ganglionectomy/cardiac sympathetic denervation (CSD) to prevent life-threatening arrhythmias and renal artery denervation (RAD) to treat resistant hypertension are now being clinically utilized, and other neuraxial approaches show a lot of promise including vagus nerve stimulation (VNS), tragus nerve stimulation, cardiac contractility modulation, baroreceptor activation therapy and spinal cord stimulation, with an optimal combination of pharmacological therapy as a management of heart failure (HF).
Keywords: Heart, cardiovascular, autonomic nervous system, nerve stimulation, arrhythmia
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