Autonomic Nervous System Dysfunction: JACC Focus Seminar

Jeffrey J. Goldberger*, Rishi Arora, Una Buckley, Kalyanam Shivkumar

*Corresponding author for this work

Research output: Contribution to journalReview articlepeer-review

169 Scopus citations


Autonomic nervous system control of the heart is a dynamic process in both health and disease. A multilevel neural network is responsible for control of chronotropy, lusitropy, dromotropy, and inotropy. Intrinsic autonomic dysfunction arises from diseases that directly affect the autonomic nerves, such as diabetes mellitus and the syndromes of primary autonomic failure. Extrinsic autonomic dysfunction reflects the changes in autonomic function that are secondarily induced by cardiac or other disease. An array of tests interrogate various aspects of cardiac autonomic control in either resting conditions or with physiological perturbations from resting conditions. The prognostic significance of these assessments have been well established. Clinical usefulness has not been established, and the precise mechanistic link to mortality is less well established. Further efforts are required to develop optimal approaches to delineate cardiac autonomic dysfunction and its adverse effects to develop tools that can be used to guide clinical decision-making.

Original languageEnglish (US)
Pages (from-to)1189-1206
Number of pages18
JournalJournal of the American College of Cardiology
Issue number10
StatePublished - Mar 19 2019


  • arrhythmia
  • autonomic
  • heart failure
  • myocardial infarction

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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