Author + information
- Received April 16, 2018
- Revision received December 21, 2018
- Accepted December 30, 2018
- Published online March 11, 2019.
- Jeffrey J. Goldberger, MDa,∗ (, )@DrJGoldberger@UMiamiHealth,
- Rishi Arora, MDb,
- Una Buckley, MDc and
- Kalyanam Shivkumar, MD, PhDc
- aCardiovascular Division, Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida
- bFeinberg Cardiovascular Research Institute, Division of Cardiology, Department of Medicine, Northwestern University-Feinberg School of Medicine, Chicago, Illinois
- cCardiac Arrhythmia Center and Neurocardiology Research Center of Excellence, University of California-Los Angeles Los Angeles, California
- ↵∗Address for correspondence:
Dr. Jeffrey J. Goldberger, University of Miami, Miller School of Medicine, Cardiovascular Division, 1120 NW 14th Street, Miami, Florida 33136.
Autonomic nervous system control of the heart is a dynamic process in both health and disease. A multilevel neural network is responsible for control of chronotropy, lusitropy, dromotropy, and inotropy. Intrinsic autonomic dysfunction arises from diseases that directly affect the autonomic nerves, such as diabetes mellitus and the syndromes of primary autonomic failure. Extrinsic autonomic dysfunction reflects the changes in autonomic function that are secondarily induced by cardiac or other disease. An array of tests interrogate various aspects of cardiac autonomic control in either resting conditions or with physiological perturbations from resting conditions. The prognostic significance of these assessments have been well established. Clinical usefulness has not been established, and the precise mechanistic link to mortality is less well established. Further efforts are required to develop optimal approaches to delineate cardiac autonomic dysfunction and its adverse effects to develop tools that can be used to guide clinical decision-making.
Dr. Goldeberger is supported by the National Heart, Lung, and Blood Institute (NHLBI) (HL70179). Dr. Arora is supported by the NHLBI (HL093490). Dr. Shivkumar is supported by the NHLBI (HL084261), by NHLBI grant R01HL084261, and by National Institutes of Health grant NIHOT2OD023848. Dr. Arora holds ownership interest in Rhythm Therapeutics, Inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Listen to this manuscript's audio summary by Editor-in-Chief Dr. Valentin Fuster on JACC.org.
- Received April 16, 2018.
- Revision received December 21, 2018.
- Accepted December 30, 2018.
- 2019 American College of Cardiology Foundation
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