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Schematization of cardiovascular regulation by the autonomic nervous system, the autonomic nervous system response to hypotension, and the role of the autonomic nervous system in reflex syncope

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Sensory nerves transfer signals from mechanoreceptors to cardiovascular (CV) centers in the medulla oblongata. Hypotension evokes a sympathetic response via activation of cardiac sympathetic nerves leading to tachycardia, increased inotropy, and vasoconstriction of blood vessels, as well as increased release of catecholamines from the adrenal glands and vasopressin from the hypophysis. In parallel, parasympathetic inhibition (via a reduction in the central vagal drive) contributes to tachycardia (vagal withdrawal). Conversely, reflex syncope starts with sympathetic withdrawal, vasodilation, and finally vagally mediated cardioinhibition.

(From: Aksu T, Brignole M, Calo L, et al. Cardioneuroablation for the treatment of reflex syncope and functional bradyarrhythmias: A Scientific Statement of the European Heart Rhythm Association of the ESC, the Heart Rhythm Society, the Asia Pacific Heart Rhythm Society and the Latin American Heart Rhythm Society. Europace 2024;26[8]:euae206. Creative Commons Attribution 4.0 International [CC BY 4.0] license, creativecommons.org/licenses/by/4.0.)