Neural Effects on Cardiac Electrophysiology

The interaction between brain and heart involves many actors, among which the sympathetic nervous system plays a major role. Since the first description of adrenoceptors by Raymond Ahlquist in 1948 and the use of beta-blockers by Sir James W. Black in patients with angina pectoris 10 years later, molecular cardiology has been investigating the intimate mechanisms enabling cardiac muscle to adapt (or maladapt) to emotional stress or physical demand. This continuous effort, exploiting state-of-the-art technologies to date, led to an impressive progress in our understanding of the machinery nearby the beta-adrenergic receptor and underneath, much more complex than imagined by pioneering studies of neural-brain axis. This review examines the features of these receptors – subtypes, localization, pathways, and effectors – mediating electrophysiological response of cardiomyocytes, with particular emphasis to control of excitation contraction coupling mechanisms and implications for arrhythmogenesis and cardiomyopathies.