Cardiac autonomic innervation

J Nucl Cardiol. 2017 Oct;24(5):1558-1570. doi: 10.1007/s12350-016-0725-7. Epub 2016 Nov 14.


The autonomic nervous system plays a key role in regulating changes in the cardiovascular system and its adaptation to various human body functions. The sympathetic arm of the autonomic nervous system is associated with the fight and flight response, while the parasympathetic division is responsible for the restorative effects on heart rate, blood pressure, and contractility. Disorders involving these two divisions can lead to, and are seen as, a manifestation of most common cardiovascular disorders. Over the last few decades, extensive research has been performed establishing imaging techniques to quantify the autonomic dysfunction associated with various cardiovascular disorders. Additionally, several techniques have been tested with variable success in modulating the cardiac autonomic nervous system as treatment for these disorders. In this review, we summarize basic anatomy, physiology, and pathophysiology of the cardiac autonomic nervous system including adrenergic receptors. We have also discussed several imaging modalities available to aid in diagnosis of cardiac autonomic dysfunction and autonomic modulation techniques, including pharmacologic and device-based therapies, that have been or are being tested currently.

Keywords: MIBG imaging; PET/CT imaging; SPECT; receptor imaging.

Publication types

  • Review

MeSH terms

  • 3-Iodobenzylguanidine
  • Animals
  • Arrhythmias, Cardiac / diagnostic imaging
  • Autonomic Nervous System / diagnostic imaging*
  • Autonomic Nervous System Diseases / diagnostic imaging*
  • Blood Pressure
  • Heart / innervation*
  • Heart Rate
  • Humans
  • Parasympathetic Nervous System
  • Positron-Emission Tomography*
  • Radiopharmaceuticals
  • Receptors, Adrenergic / metabolism
  • Tomography, Emission-Computed, Single-Photon*


  • Radiopharmaceuticals
  • Receptors, Adrenergic
  • 3-Iodobenzylguanidine