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Current Cardiology Reviews

Author(s): Shantala S. Herlekar*, Ashwini R. Doyizode, Savitri P. Siddangoudra and Anupama V.

DOI: 10.2174/011573403X284831240408053528

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Cardiovascular Reflexes - Vagus as the Key Player

Article ID: e290424229476 Pages: 17

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Abstract

The cardiac and vascular systems work in coordination by activating various reflex mechanisms based on the body’s needs. These may be during physiological variations or pathophysiological changes seen in disease conditions of varying degrees of severity. This article intends to explain various reflexes involved in the homeostasis of the cardiovascular system and the role of vagus as the key component in all these reflexes. The article also explains the components of the reflex arc, the stimulus and response, and the role of reflex in a few diseases. This article describes 22 different cardiovascular reflexes in detail.

Keywords: Vagus, Sino-aortic nerves, cardio-vascular reflexes, baroreceptor resetting, mareys reflex, reverse bainbridege reflex.

Graphical Abstract

[1]
Kenny BJ, Bordoni B. Human Physiology. New Delhi: CBS Publishers and Distributors Pvt Ltd 2016.
[2]
Chatterjee CC. Neuroanatomy, Cranial Nerve 10 (Vagus Nerve). Treasure Island, FL: StatPearls Publishing 2023.
[3]
Levy MN, Pappano AJ. Cardiovascular Physiology. Philadelphia: Elsevier Publishers 2007.
[4]
Guyton AC, Hall JE. Textbook of medical physiology. Philadelphia: Elsevier Publishers 2006; pp. 103-287.
[5]
Barrett KE, Barman SM. Ganong’s Review of Medical Physiology. New York, United States: McGraw Hill Professional 2012; p. 768.
[6]
Khurana I. Textbook of Medical Physiology. Noida: Elsevier Publishers 2009; pp. 241-384.
[7]
Piepoli M, Sleight P, Leuzzi S, et al. Origin of respiratory sinus arrhythmia in conscious humans. An important role for arterial carotid baroreceptors. Circulation 1997; 95(7): 1813-21.
[http://dx.doi.org/10.1161/01.CIR.95.7.1813] [PMID: 9107168]
[8]
Image source. 2014. Available From: https://healthfixit.com/wp-content/uploads/2014/06/The-Origin-and-Distribution-of-the-Vagus-Nerve-image.jpg
[9]
Dixon A, Thibodeau R, Gabbrielli R. Vagus nerve. 2024. Available From https://radiopaedia.org/articles/vagus-nerve
[10]
Baker E, Lui F. Neuroanatomy, vagal nerve nuclei. Treasure Island, FL: StatPearls Publishing 2024.
[11]
Eckberg DL. Human sinus arrhythmia as an index of vagal cardiac outflow. J Appl Physiol 1983; 54(4): 961-6.
[http://dx.doi.org/10.1152/jappl.1983.54.4.961] [PMID: 6853303]
[12]
Koepchen HP, Abel HH, Klussendorf D. Central cardiorespiratory organizationNeural Mechanisms and Cardiovascular Disease. Padua, Italy: Liviana Press 1986; pp. 119-31.
[13]
Shykoff BE, Naqvi SS, Menon AS, Slutsky AS. Respiratory sinus arrhythmia in dogs. Effects of phasic afferents and chemostimulation. J Clin Invest 1991; 87(5): 1621-7.
[http://dx.doi.org/10.1172/JCI115176] [PMID: 1902491]
[14]
Spyer KM. Annual review prize lecture. Central nervous mechanisms contributing to cardiovascular control. J Physiol 1994; 474(1): 1-19.
[http://dx.doi.org/10.1113/jphysiol.1994.sp019997] [PMID: 8014887]
[15]
Soos MP, McComb D. Sinus Arrhythmia. Treasure Island, FL: StatPearls Publishing 2023.
[16]
Porzionato A, Macchi V, Stecco C, De Caro R. The carotid sinus nerve—structure, function, and clinical implications. Anat Rec (Hoboken) 2019; 302(4): 575-87.
[http://dx.doi.org/10.1002/ar.23829] [PMID: 29663677]
[17]
Purkayastha S, Maffuid K, Zhu X, Zhang R, Raven PB. The influence of the carotid baroreflex on dynamic regulation of cerebral blood flow and cerebral tissue oxygenation in humans at rest and during exercise. Eur J Appl Physiol 2018; 118(5): 959-69.
[http://dx.doi.org/10.1007/s00421-018-3831-1] [PMID: 29497836]
[18]
Armstrong M, Kerndt CC, Moore RA. Physiology, Baroreceptors. Treasure Island, FL: StatPearls Publishing 2023.
[19]
Herlekar SS. Revisiting cardiovascular reflexes and resetting in healthy adolescents to analyse mechanisms of physiological and pathophysiological factors influencing individual blood-pressure components. J Stress Physiol Biochem 2021; 17(2): 45-54.
[20]
Dean C, Bago M. Renal sympathoinhibition mediated by 5-HT(1A) receptors in the RVLM during severe hemorrhage in rats. Am J Physiol Regul Integr Comp Physiol 2002; 282(1): R122-30.
[21]
Hong JM, Kim T, Shin DH, Lee J, Joo I. Cardiovascular autonomic function in lateral medullary infarction. Neurol Sci 2013; 34(11): 1963-9.
[http://dx.doi.org/10.1007/s10072-013-1420-y]
[22]
Raven PB, Fadel PJ, Ogoh S. Arterial baroreflex resetting during exercise: A current perspective. Exp Physiol 2006; 91(1): 37-49.
[http://dx.doi.org/10.1113/expphysiol.2005.032250] [PMID: 16210446]
[23]
Andresen MC, Yang M. Arterial baroreceptor resetting: Contributions of chronic and acute processes. Clin Exp Pharmacol Physiol 1989; 16(s15): 19-30.
[http://dx.doi.org/10.1111/j.1440-1681.1989.tb02993.x] [PMID: 2805444]
[24]
Korner PI. Baroreceptor resetting and other determinants of baroreflex properties in hypertension. Clin Exp Pharmacol Physiol 1989; 16(s15): 45-64.
[http://dx.doi.org/10.1111/j.1440-1681.1989.tb02995.x] [PMID: 2680189]
[25]
Suarez-Roca H, Mamoun N, Sigurdson MI, Maixner W. Baroreceptor modulation of the cardiovascular system, pain, consciousness, and cognition. Compr Physiol 2021; 11(2): 1373-423.
[http://dx.doi.org/10.1002/cphy.c190038] [PMID: 33577130]
[26]
Klabunde RE. Cardiovascular physiology concepts: New third edition. Netherlands: Wolters Kluwer 2021.
[27]
Miyakawa K. Mechanisms of blood pressure oscillation caused by central nervous system ischemic response. Jpn J Physiol 1988; 38(4): 399-425.
[http://dx.doi.org/10.2170/jjphysiol.38.399] [PMID: 3070104]
[28]
Pandya SR. Mechanisms of blood pressure oscillation caused by central nervous system ischemic response. Cent Nerv Syst Agents Med Chem 2011; 11(2): 81-97.
[29]
Zhao M, Guan L, Wang Y. The association of autonomic nervous system function with ischemic stroke, and treatment strategies. Front Neurol 2020; 10: 1411.
[http://dx.doi.org/10.3389/fneur.2019.01411] [PMID: 32038467]
[30]
Dinallo S, Waseem M. Cushing reflex. Florida, United States: StatPearls 2022.
[31]
Wan WH, Ang BT, Wang E. The cushing response: A case for a review of its role as a physiological reflex. J Clin Neurosci 2008; 15(3): 223-8.
[http://dx.doi.org/10.1016/j.jocn.2007.05.025] [PMID: 18182296]
[32]
Grady PA, Blaumanis OR. Physiologic parameters of the cushing reflex. Surg Neurol 1988; 29(6): 454-61.
[http://dx.doi.org/10.1016/0090-3019(88)90140-1] [PMID: 3375974]
[33]
Tsai YH, Lin JY, Huang YY, Wong JM. Cushing response-based warning system for intensive care of brain-injured patients. Clin Neurophysiol 2018; 129(12): 2602-12.
[http://dx.doi.org/10.1016/j.clinph.2018.09.010] [PMID: 30453271]
[34]
Crystal GJ, Salem MR. The Bainbridge and the “reverse” Bainbridge reflexes: History, physiology, and clinical relevance. Anesth Analg 2012; 114(3): 520-32.
[http://dx.doi.org/10.1213/ANE.0b013e3182312e21] [PMID: 21965361]
[35]
Bainbridge FA. The influence of venous filling upon the rate of the heart. J Physiol 1915; 50(2): 65-84.
[http://dx.doi.org/10.1113/jphysiol.1915.sp001736] [PMID: 16993330]
[36]
Cui J, Gao Z, Blaha C, Herr MD, Mast J, Sinoway LI. Distension of central great vein decreases sympathetic outflow in humans. Am J Physiol Heart Circ Physiol 2013; 305(3): H378-85.
[http://dx.doi.org/10.1152/ajpheart.00019.2013] [PMID: 23729210]
[37]
Petersen LG, Damgaard M, Petersen JC, Norsk P. Mechanisms of increase in cardiac output during acute weightlessness in humans. J Appl Physiol 1985; 111(2): 407-11.
[38]
18 Regulation of the Heart and Vasculature. 2008. Available From: http://users.atw.hu/blp6/BLP6/HTML/C0189780323045827.htm
[39]
Hainsworth R. Reflexes from the heart. Physiol Rev 1991; 71(3): 617-58.
[http://dx.doi.org/10.1152/physrev.1991.71.3.617] [PMID: 2057525]
[40]
Hakumäki MOK. Seventy years of the Bainbridge reflex. Acta Physiol Scand 1987; 130(2): 177-85.
[http://dx.doi.org/10.1111/j.1748-1716.1987.tb08126.x] [PMID: 3300168]
[41]
Frank O. Zur dynamic des herzmuskels. Z Biol (Münch) 1895; 32: 370-437.
[42]
Patterson SW, Piper H, Starling EH. The regulation of the heart beat. J Physiol 1914; 48(6): 465-513.
[http://dx.doi.org/10.1113/jphysiol.1914.sp001676] [PMID: 16993269]
[43]
Linden RJ. Atrial reflexes and renal function. Am J Cardiol 1979; 44(5): 879-83.
[http://dx.doi.org/10.1016/0002-9149(79)90217-0] [PMID: 495495]
[44]
Kappagoda CT, Linden RJ, Mary DASG, Weatherill D. Atrial receptors which effect a reflex decrease in renal sympathetic activity. [proceedings]. J Physiol 1978; 280: 61P-2P.
[PMID: 690924]
[45]
Kappagoda CT, Linden RJ, Snow HM, Whitaker EM. Left atrial receptors and the antidiuretic hormone. J Physiol 1974; 237(3): 663-83.
[http://dx.doi.org/10.1113/jphysiol.1974.sp010503] [PMID: 4825477]
[46]
Kappagoda CT, Linden RJ, Sreeharan N. The role of renal nerves in the diuresis and natriuresis caused by stimulation of atrial receptors. J Physiol 1979; 287: 17P-8.
[PMID: 430392]
[47]
Warltier DC, Campagna JA, Carter C. Clinical relevance of the Bezold-Jarisch reflex. Anesthesiology 2003; 98(5): 1250-60.
[http://dx.doi.org/10.1097/00000542-200305000-00030] [PMID: 12717149]
[48]
Aviado DM, Aviado DG. The Bezold-Jarisch reflex. A historical perspective of cardiopulmonary reflexes. Ann N Y Acad Sci 2001; 940(1): 48-58.
[http://dx.doi.org/10.1111/j.1749-6632.2001.tb03666.x] [PMID: 11458703]
[49]
Mark AL. The Bezold-Jarisch reflex revisited: Clinical implications of inhibitory reflexes originating in the heart. J Am Coll Cardiol 1983; 1(1): 90-102.
[http://dx.doi.org/10.1016/S0735-1097(83)80014-X] [PMID: 6826948]
[50]
Arya S, Belwal S, Uniyal B, Tiwari B, Sharma P. Bezold Jarisch reflex-new interest, old phenomenon. Ameri J Int Med 2020; 8(1): 24-9.
[http://dx.doi.org/10.11648/j.ajim.20200801.15]
[51]
Noakes TD. The forgotten Barcroft/Edholm reflex: Potential role in exercise associated collapse. Br J Sports Med 2003; 37(3): 277-8.
[http://dx.doi.org/10.1136/bjsm.37.3.277] [PMID: 12782559]
[52]
Noakes TD. Reduced peripheral resistance and other factors in marathon collapse. Sports Med 2007; 37(4): 382-5.
[http://dx.doi.org/10.2165/00007256-200737040-00028] [PMID: 17465614]
[53]
Zelis R, Flaim SF. Alterations in vasomotor tone in congestive heart failure. Prog Cardiovasc Dis 1982; 24(6): 437-59.
[http://dx.doi.org/10.1016/0033-0620(82)90012-3] [PMID: 6805039]
[54]
Mack EH. Neurogenic Shock. Open Pediatr Med J 2013; 7(1): 16-8.
[http://dx.doi.org/10.2174/1874309901307010016]
[55]
Krassioukov A, Claydon VE. The clinical problems in cardiovascular control following spinal cord injury: An overview. Prog Brain Res. 2006; 152: pp. 223-9.
[http://dx.doi.org/10.1016/S0079-6123(05)52014-4] [PMID: 16198703]
[56]
Bravo G, Guízar-Sahagún G, Ibarra A, Centurión D, Villalón C. Cardiovascular alterations after spinal cord injury: An overview. Curr Med Chem Cardiovasc Hematol Agents 2004; 2(2): 133-48.
[http://dx.doi.org/10.2174/1568016043477242] [PMID: 15320796]
[57]
Philpott A, Anderson TJ. Reactive hyperemia and cardiovascular risk. Arterioscler Thromb Vasc Biol 2007; 27(10): 2065-7.
[http://dx.doi.org/10.1161/ATVBAHA.107.149740] [PMID: 17881738]
[58]
Pyke KE, Tschakovsky ME. Peak vs. total reactive hyperemia: Which determines the magnitude of flow-mediated dilation? J Appl Physiol 2007; 102(4): 1510-9.
[http://dx.doi.org/10.1152/japplphysiol.01024.2006] [PMID: 17170205]
[59]
Tagawa T, Imaizumi T, Endo T, Shiramoto M, Harasawa Y, Takeshita A. Role of nitric oxide in reactive hyperemia in human forearm vessels. Circulation 1994; 90(5): 2285-90.
[http://dx.doi.org/10.1161/01.CIR.90.5.2285] [PMID: 7955185]
[60]
Murrant CL, Lamb IR, Novielli NM. Capillary endothelial cells as coordinators of skeletal muscle blood flow during active hyperemia. Microcirculation 2017; 24(3): e12348.
[http://dx.doi.org/10.1111/micc.12348] [PMID: 28036147]
[61]
Clifford PS. Local control of blood flow. Adv Physiol Educ 2011; 35(1): 5-15.
[http://dx.doi.org/10.1152/advan.00074.2010] [PMID: 21385995]
[62]
Revelette R, Reynolds S, Brown D, Taylor R. Effect of abdominal compression on diaphragmatic tendon organ activity. J Appl Physiol 1992; 72(1): 288-92.
[http://dx.doi.org/10.1152/jappl.1992.72.1.288] [PMID: 1537727]
[63]
Johnson PC. Autoregulation of blood flow. Circ Res 1986; 59(5): 483-95.
[http://dx.doi.org/10.1161/01.RES.59.5.483] [PMID: 3542277]
[64]
Bayliss WM. On the local reaction of the arterial wall to changes of internal pressure. J Physiol (Lond) 1902; 28(5): 220-31.
[65]
Jones RD, Berne RM. Evidence for a metabolic mechanism in autoregulation of blood flow in skeletal muscle. Circ Res 1965; 17(6): 540-54.
[http://dx.doi.org/10.1161/01.RES.17.6.540] [PMID: 5843887]
[66]
Schubert RW, Whalen WJ, Nair P. Myocardial PO2 distribution: Relationship to coronary autoregulation. Am J Physiol 1978; 234(4): H361-70.
[PMID: 645874]
[67]
Dampney RA, Stella A, Golin R, Zanchetti A. Vagal and sinoaortic reflexes in postural control of circulation and renin release. Am J Physiol 1979; 237(2): H146-52.
[PMID: 464105]
[68]
Baccelli G, Albertini R, Del Bo A, Mancia G, Zanchetti A. Role of sinoaortic reflexes in hemodynamic patterns of natural defense behaviors in the cat. Am J Physiol 1981; 240(3): H421-9.
[PMID: 7193981]
[69]
Arnold RW. The oculocardiac reflex: A review. Clin Ophthalmol 2021; 15: 2693-725.
[http://dx.doi.org/10.2147/OPTH.S317447] [PMID: 34194223]
[70]
Bharati SJ, Chowdhury T. The oculocardiac reflex Trigeminocardiac Reflex. Cambridge, Massachusetts: Academic Press 2015; pp. 89-99.
[http://dx.doi.org/10.1016/B978-0-12-800421-0.00007-2]
[71]
Patel S, Barnacle A, Mailli L, Osborne S, Vahdani K, Ratnam L. The Oculocardiac Reflex: A rare but significant cardiovascular complication during percutaneous sclerotherapy of a retro-bulbar low flow venolymphatic malformation. Cardiovasc Intervent Radiol 2023; 46(3): 411-3.
[http://dx.doi.org/10.1007/s00270-022-03337-2] [PMID: 36539513]
[72]
Godek D, Freeman AM. Physiology, Diving Reflex. Treasure Island, FL: StatPearls Publishing 2022.
[73]
Buchholz B, Kelly J, Bernatene EA, Méndez Diodati N, Gelpi RJ. Antagonistic and synergistic activation of cardiovascular vagal and sympathetic motor outflows in trigeminal reflexes. Front Neurol 2017; 8: 52.
[http://dx.doi.org/10.3389/fneur.2017.00052] [PMID: 28270794]
[74]
Smith G, Morgans A, Taylor DM, Cameron P. Use of the human dive reflex for the management of supraventricular tachycardia: A review of the literature. Emerg Med J 2012; 29(8): 611-6.
[http://dx.doi.org/10.1136/emermed-2011-200877] [PMID: 22389355]
[75]
Hurwitz BE, Furedy JJ. The human dive reflex: An experimental, topographical and physiological analysis. Physiol Behav 1986; 36(2): 287-94.
[http://dx.doi.org/10.1016/0031-9384(86)90018-1] [PMID: 3961003]
[76]
Longo DL, Fauci AS, Kasper DL. Disorders of the Autonomic Nervous System. Harrisons Principal Of Internal Medicine. New York: McGraw-Hill companies Inc 2022; p. 3351.
[77]
Valsalva AM. The Valsalva maneuver. Treasure Island, FL: StatPearls 2021.
[78]
Nishimura RA. The Valsalva maneuver and response revisited. Mayo Clin Proc 1986; 61(3): 211-7.
[79]
Porth CJ, Bamrah VS, Tristani FE, Smith JJ. The Valsalva maneuver: Mechanisms and clinical implications. Heart Lung 1984; 13(5): 507-18.
[80]
Pstras L, Thomaseth K, Waniewski J, Balzani I, Bellavere F. The Valsalva manoeuvre: Physiology and clinical examples. Acta Physiol (Oxf) 2016; 217(2): 103-19.
[http://dx.doi.org/10.1111/apha.12639] [PMID: 26662857]
[81]
Appelboam A, Reuben A, Mann C, et al. Postural modification to the standard Valsalva manoeuvre for emergency treatment of supraventricular tachycardias (REVERT): A randomised controlled trial. Lancet 2015; 386(10005): 1747-53.
[http://dx.doi.org/10.1016/S0140-6736(15)61485-4] [PMID: 26314489]
[82]
Heusch G. Vagal cardioprotection in reperfused acute myocardial infarction. JACC Cardiovasc Interv 2017; 10(15): 1521-2.
[http://dx.doi.org/10.1016/j.jcin.2017.05.063] [PMID: 28797428]
[83]
Wang S, Ye X, Wei J, Xia Z. Remote ischemic preconditioning for cardioprotection in patients undergoing cardiac surgery: A systemic review. Transl Perioper Pain Med 2020; 7(3): 238-47.
[84]
Heusch G, Bøtker HE, Przyklenk K, Redington A, Yellon D. Remote ischemic conditioning. J Am Coll Cardiol 2015; 65(2): 177-95.
[http://dx.doi.org/10.1016/j.jacc.2014.10.031] [PMID: 25593060]
[85]
Gourine A, Gourine AV. Neural mechanisms of cardioprotection. Physiology (Bethesda) 2014; 29(2): 133-40.
[http://dx.doi.org/10.1152/physiol.00037.2013] [PMID: 24583769]
[86]
Gourine A, Gourine AV, Mastitskaya S, Ackland G. “Remote preconditioning reflex”: A neural pathway of cardioprotection during myocardial ischaemia and reperfusion induced by remote ischemic preconditioning. Eur Heart J 2010; 31: 319. [Google Scholar].
[87]
Jones WK, Fan GC, Liao S, et al. Peripheral nociception associated with surgical incision elicits remote nonischemic cardioprotection via neurogenic activation of protein kinase C signaling. Circulation 2009; 120(11) (Suppl. 1): S1-9.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.108.843938] [PMID: 19752352]
[88]
Pasquier M, Clair M, Pruvot E, Hugli O, Carron PN. Carotid Sinus Massage. The New England J Med 2017; 377(15): 78.
[89]
Huang EPC, Chen CH, Fan CY, Sung CW, Lai PC, Huang YT. Comparison of various vagal maneuvers for supraventricular tachycardia by network meta-analysis. Front Med (Lausanne) 2022; 8: 769437.
[http://dx.doi.org/10.3389/fmed.2021.769437] [PMID: 35186966]
[90]
Blomström-Lundqvist C, Scheinman MM, Aliot EM, et al. ACC/AHA/ESC guidelines for the management of patients with supraventricular arrhythmias--executive summary. A report of the American college of cardiology/American heart association task force on practice guidelines and the European society of cardiology committee for practice guidelines (writing committee to develop guidelines for the management of patients with supraventricular arrhythmias) developed in collaboration with NASPE-Heart Rhythm Society. J Am Coll Cardiol 2003; 42(8): 1493-531.
[PMID: 14563598]
[91]
Neumar RW, Otto CW, Link MS, et al. Adult advanced cardiovascular life support: 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care. Circulation 2010; 122(18) (Suppl. 3): S729-67.
[http://dx.doi.org/10.1161/CIRCULATIONAHA.110.970988] [PMID: 20956224]
[92]
Brignole M, Alboni P, Benditt DG, et al. Guidelines on Management (diagnosis and treatment) of syncope? update 2004. Europace 2004; 6(6): 467-537.
[http://dx.doi.org/10.1016/j.eupc.2004.08.008] [PMID: 15519256]
[93]
Gronda E, Francis D, Zannad F, Hamm C, Brugada J, Vanoli E. Baroreflex activation therapy. J Cardiovasc Med (Hagerstown) 2017; 18(9): 641-9.
[http://dx.doi.org/10.2459/JCM.0000000000000544] [PMID: 28737621]
[94]
Sabbah HN. Baroreflex activation for the treatment of heart failure. Curr Cardiol Rep 2012; 14(3): 326-33.
[http://dx.doi.org/10.1007/s11886-012-0265-y] [PMID: 22528555]
[95]
Duncker D, Bauersachs J. Current and future use of neuromodulation in heart failure. Eur Heart J Suppl 2022; 24 (Suppl. E): E28-34.
[http://dx.doi.org/10.1093/eurheartjsupp/suac031] [PMID: 35991620]
[96]
De Ferrari GM, Crijns HJGM, Borggrefe M, et al. Chronic vagus nerve stimulation: A new and promising therapeutic approach for chronic heart failure. Eur Heart J 2011; 32(7): 847-55.
[http://dx.doi.org/10.1093/eurheartj/ehq391] [PMID: 21030409]
[97]
Chiou CW, Eble JN, Zipes DP. Efferent vagal innervation of the canine atria and sinus and atrioventricular nodes. Circulation 1997; 95(11): 2573-84.
[http://dx.doi.org/10.1161/01.CIR.95.11.2573]
[98]
Pachon MJC, Pachon ME, Lobo TJ, et al. Syncopal high-degree AV block treated with catheter RF ablation without pacemaker implantation. Pacing Clin Electrophysiol 2006; 29(3): 318-22.
[http://dx.doi.org/10.1111/j.1540-8159.2006.00340.x] [PMID: 16606401]
[99]
Pachon MJC, Pachon MEI, Pachon MJC, et al. “Cardioneuroablation” – new treatment for neurocardiogenic syncope, functional AV block and sinus dysfunction using catheter RF-ablation. Europace 2005; 7(1): 1-13.
[http://dx.doi.org/10.1016/j.eupc.2004.10.003]
[100]
Antolic B, Gorisek VR, Granda G, Lorber B, Sinkovec M, Zizek D. Cardioneuroablation in ictal asystole—New treatment method. HeartRhythm Case Rep 2018; 4(11): 523-6.
[http://dx.doi.org/10.1016/j.hrcr.2018.07.018] [PMID: 30479951]