Brain and Heart Dynamics

The understanding of cardiac neuronal control has dramatically evolved in the last 50 years, both from an anatomical and a functional point of view. Cardiac neuronal control is mediated via a series of reflex control networks involving somata in the (i) intrinsic cardiac ganglia (heart), (ii) intrathoracic extracardiac ganglia (stellate, middle cervical), (iii) superior cervical ganglia, (iv) spinal cord, (v) brainstem, and (vi) higher centers. Each of these processing centers contains afferent, efferent, and local circuit neurons, which interact locally and in an interdependent fashion with the other levels V. Dusi (*) Department ofMolecularMedicine, Section of Cardiology, University of Pavia, Pavia, Italy Cardiac Intensive Care Unit, Arrhythmia and Electrophysiology and Experimental Cardiology, Fondazione IRCCS Policlinico San Matteo, Pavia, Italy e-mail: veronica.dusi@gmail.com; veronica.dusi@unipv.it J. L. Ardell Neurocardiology Research Center of Excellence, University of California, Los Angeles, CA, USA Cardiac Arrhythmia Center, University of California, Los Angeles, CA, USA e-mail: jardell@mednet.ucla.edu © Springer Nature Switzerland AG 2020 S. Govoni et al. (eds.), Brain and Heart Dynamics, https://doi.org/10.1007/978-3-030-28008-6_2 3 to coordinate regional cardiac electrical and mechanical indices on a beat-to-beat basis. This neuronal control system shows plasticity and memory capacity, allowing it to maintain an adequate cardiac function in response to normal physiological stressors such as standing and exercise. Yet, pathological events such as myocardial ischemia as well as any other type of cardiac stressor may overcome the homeostatic capability of the system, leading to excessive sympathoexcitation coupled with withdrawal of central parasympathetic drive. In turn, autonomic dysregulation is central to the evolution of heart failure and the development of life-threatening arrhythmias. As such, understanding the anatomical and physiological basis for cardiac neuronal control is crucial to implement effectively novel neuromodulation therapies to mitigate the progression of cardiac diseases.