The autonomic nervous system (ANS) with its two limbs, the sympathetic (SNS) and parasympathetic nervous system (PSNS), plays a critical role in the modulation of cardiac arrhythmogenesis. It can be both pro- and/or anti-arrhythmic at both the atrial and ventricular level of the myocardium. Intricate mechanisms, different for specific cardiac arrhythmias, are involved in this modulatory process. More data are available for the arrhythmogenic effects of the SNS, which, when overactive, can trigger atrial and/or ventricular “adrenergic” arrhythmias in susceptible individuals (e.g. in patients with paroxysmal atrial fibrillation-PAF, ventricular pre-excitation, specific channelopathies, ischemic heart disease or cardiomyopathies), while it can also negate the protective anti-arrhythmic drug effects. However, there is also evidence that PSNS overactivity may be responsible for triggering “vagotonic” arrhythmias (e.g. PAF, Brugada syndrome, idiopathic ventricular fibrillation). Thus, a fine balance is necessary to attain in these two limbs of the ANS in order to maintain eurhythmia, which is a difficult task to accomplish. Over the years, in addition to classical drug therapies, where beta-blockers prevail, several ANS-modulating interventions have been developed aiming at prevention and management of arrhythmias. Among them, techniques of cardiac sympathetic denervation, renal denervation, vagal stimulation, ganglionated plexi ablation and the newer experimental method of optogenetics have been employed. However, in many arrhythmogenic diseases, ANS modulation is still an investigative tool. Initial data are encouraging; however, further studies are needed to explore the efficacy of such interventions. These issues are herein reviewed and old and recent literature data are discussed, tabulated and pictorially illustrated.

自主神经系统 (ANS) 及其两个分支，即交感神经 (SNS) 和副交感神经系统 (PSNS)，在调节心律失常中起着关键作用。它可以在心肌的心房和心室水平上促进和/或抗心律失常。这种调节过程涉及复杂的机制，与特定的心律失常不同。有更多关于 SNS 致心律失常效应的数据可用，SNS 过度活跃时可引发易感个体的心房和/或心室“肾上腺素能”心律失常（例如，阵发性心房颤动-PAF、心室预激、特定通道病、缺血性心脏病或心肌病），同时它也可以抵消保护性抗心律失常药物的作用。然而，还有证据表明，PSNS 过度活跃可能是触发“迷走神经性”心律失常（例如 PAF、Brugada 综合征、特发性心室颤动）的原因。因此，为了维持心律失常，需要在 ANS 的这两个肢体中获得良好的平衡，这是一项艰巨的任务。多年来，除了 β 受体阻滞剂盛行的经典药物疗法外，还开发了多种 ANS 调节干预措施，旨在预防和管理心律失常。其中，心脏去交感神经、肾脏去神经、迷走神经刺激、神经节丛消融技术和光遗传学的新实验方法已被采用。然而，在许多致心律失常疾病中，ANS 调节仍然是一种研究工具。初步数据令人鼓舞；然而，需要进一步研究以探讨此类干预措施的功效。本文对这些问题进行了审查，并对旧的和最近的文献数据进行了讨论、制表和图解说明。