Cardiac vagal afferent neurotransmission in health and disease: review and knowledge gaps

Abstract

The meticulous control of cardiac sympathetic and parasympathetic tone regulates all facets of cardiac function. This precise calibration of cardiac efferent innervation is dependent on sensory information that is relayed from the heart to the central nervous system. The vagus nerve, which contains vagal cardiac afferent fibers, carries sensory information to the brainstem. Vagal afferent signaling has been predominantly shown to increase parasympathetic efferent response and vagal tone. However, cardiac vagal afferent signaling appears to change after cardiac injury, though much remains unknown. Even though subsequent cardiac autonomic imbalance is characterized by sympathoexcitation and parasympathetic dysfunction, it remains unclear if, and to what extent, vagal afferent dysfunction is involved in the development of vagal withdrawal. This review aims to summarize the current understanding of cardiac vagal afferent signaling under in health and in the setting of cardiovascular disease, especially after myocardial infarction, and to highlight the knowledge gaps that remain to be addressed.

Neural Circuits Underlying Reciprocal Cardiometabolic Crosstalk: 2023 Arthur C. Corcoran Memorial Lecture

“…37,38 Modulation of the autonomic nervous system by the cardiac afferent reflex represents another mechanism that can mediate the effect of the heart on metabolism. 39–43 This possibility is supported by several studies implicating sympathetic traffic in heart failure–associated cachexia caused by excess loss of adiposity. 44,45 Remarkably, a prospective study identified muscle sympathetic nerve activity as the most sensitive marker of weight loss in heart failure patients.…”

Cardiopulmonary nerve stimulation as a novel therapy for cardiac autonomic nervous system modulation

“…We hypothesize that during CPNS therapy, afferent signaling is modulated either directly by direct stimulation of afferent nerve fibers or indirectly by reacting to the low-level CPNS sympathetic stimulation. The CANS controls the sympathetic and parasympathetic outflow based on the afferent/sensory input and therefore afferent modulation could cause a significant change in the whole CANS (Chen et al, 2015 ; van Weperen and Vaseghi, 2023 ).…”

Cardiopulmonary nerve stimulation as a novel therapy for cardiac autonomic nervous system modulation

“…We hypothesize that during CPNS therapy, afferent signaling is modulated either directly by direct stimulation of afferent nerve fibers or indirectly by reacting to the low-level CPNS sympathetic stimulation. The CANS controls the sympathetic and parasympathetic outflow based on the afferent/sensory input and therefore afferent modulation could cause a significant change in the whole CANS (Chen et al, 2015;van Weperen and Vaseghi, 2023).…”