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The autonomic nervous system plays a significant role in the genesis and maintenance
of ventricular arrhythmias, modulating the underlying substrate in a dynamic manner.
Multiple studies employing systemic and local modulation of the nervous system whether
through medications or neuraxial modulation have been associated with a reduction
in the risk of sudden cardiac death and burden of ventricular arrhythmias. Initially,
cardiac neural anatomy and neural remodeling in the setting of scar and cardiomyopathy
will be reviewed. Subsequently, the mechanisms of autonomic modulation of cardiac
excitability in health and in disease that causes arrhythmias will be discussed. Then
the rationale for various neuraaxial modulation approaches (stellate ganglionectomy,
thoracic epidural anesthesia, spinal cord stimulation and vagal nerve stimulation)
in reducing the risk of ventricular arrhythmias will be discussed. The efficacy of
stellate ganglionectomy in humans including, feasibility, surgical techniques, and
complications will be discussed.
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