[{"data":1,"prerenderedAt":-1},["ShallowReactive",2],{"detail-sidebar-cat-0-en-105":3,"doc-seo-449301-105":59,"doc-detail-449301-en":131},{"code":4,"msg":5,"data":6},0,"success",[7,13,18,23,28,33,38,43,48,51,55],{"id":8,"doc_module":4,"doc_module_name":9,"category_name":10,"show_sort_weight":11,"slug":12},1,"Document","Story & Novel",90,"story-novel",{"id":14,"doc_module":4,"doc_module_name":9,"category_name":15,"show_sort_weight":16,"slug":17},2,"Literature",80,"literature",{"id":19,"doc_module":4,"doc_module_name":9,"category_name":20,"show_sort_weight":21,"slug":22},4,"Exam",70,"exam",{"id":24,"doc_module":4,"doc_module_name":9,"category_name":25,"show_sort_weight":26,"slug":27},5,"Comic",60,"comic",{"id":29,"doc_module":4,"doc_module_name":9,"category_name":30,"show_sort_weight":31,"slug":32},6,"Technology",50,"technology",{"id":34,"doc_module":4,"doc_module_name":9,"category_name":35,"show_sort_weight":36,"slug":37},7,"Healthcare",40,"healthcare",{"id":39,"doc_module":4,"doc_module_name":9,"category_name":40,"show_sort_weight":41,"slug":42},8,"Research & Report",30,"research-report",{"id":44,"doc_module":4,"doc_module_name":9,"category_name":45,"show_sort_weight":46,"slug":47},9,"Religion & Spirituality",20,"religion-spirituality",{"id":46,"doc_module":4,"doc_module_name":9,"category_name":49,"show_sort_weight":46,"slug":50},"World Cup","world-cup",{"id":52,"doc_module":4,"doc_module_name":9,"category_name":53,"show_sort_weight":52,"slug":54},10,"Lifestyle","lifestyle",{"id":56,"doc_module":4,"doc_module_name":9,"category_name":57,"show_sort_weight":24,"slug":58},19,"General","general",{"code":4,"msg":60,"data":61},"ok",{"site_id":62,"language":63,"slug":64,"title":65,"keywords":66,"description":67,"schema_data":68,"social_meta":124,"head_meta":126,"extra_data":128,"updated_unix":130},105,"en","cardiac-endogenous-transmitter-system-molecular-features-functions-and-clinical-implications","Cardiac endogenous transmitter system: molecular features, functions, and clinical implications","","Transmitter-based model of cardiac bioelectric regulation links endogenous transmitter systems in the heart to arrhythmia mechanisms and therapeutic opportunities. Glutamatergic, cholinergic, and GABAergic systems generate ligand-gated currents in cardiomyocytes and atrioventricular node pacemaker cells, shaping automaticity, excitability, and conductivity. When these finely tuned pathways become destabilized, electrical dyshomeostasis promotes arrhythmias including atrial fibrillation, atrioventricular block, and ventricular tachyarrhythmias. Molecular components such as synthesizing enzymes, receptors, and transporters offer pharmacologic targets to restore stability and suppress arrhythmogenic signaling, reframing cardiac conduction beyond ion channels and gap junctions.",{"@graph":69,"@context":123},[70,84,106],{"@type":71,"itemListElement":72},"BreadcrumbList",[73,77,79,82],{"item":74,"name":75,"@type":76,"position":8},"https://docshare.wps.com","Home","ListItem",{"item":78,"name":9,"@type":76,"position":14},"https://docshare.wps.com/document/",{"item":80,"name":35,"@type":76,"position":81},"https://docshare.wps.com/document/healthcare/",3,{"item":83,"name":65,"@type":76,"position":19},"https://docshare.wps.com/document/cardiac-endogenous-transmitter-system-molecular-features-functions-and-clinical-implications/449301/",{"url":83,"name":65,"@type":85,"image":86,"author":91,"headline":65,"publisher":94,"fileFormat":97,"inLanguage":63,"description":67,"dateModified":98,"datePublished":99,"encodingFormat":97,"isAccessibleForFree":100,"interactionStatistic":101},"DigitalDocument",{"url":87,"@type":88,"width":89,"height":90},"https://docshare.wps.com/thumbnails/cardiac-endogenous-transmitter-system-molecular-features-functions-and-clinical-implications/449301.png","ImageObject",300,407,{"name":92,"@type":93},"Ben ","Person",{"url":74,"name":95,"@type":96},"DocShare","Organization","application/pdf","2026-11-05","2026-09-30",true,{"@type":102,"interactionType":103,"userInteractionCount":105},"InteractionCounter",{"@type":104},"ViewAction",17,{"@type":107,"mainEntity":108},"FAQPage",[109,115,119],{"name":110,"@type":111,"acceptedAnswer":112},"What is the endogenous transmitter system (ETS) concept in the heart?","Question",{"text":113,"@type":114},"The review proposes that the heart contains endogenous transmitter systems within cardiomyocytes and cardiac pacemaker cells, enabling transmitter-based regulation of cardiac bioelectric properties.","Answer",{"name":116,"@type":111,"acceptedAnswer":117},"Which transmitter systems are emphasized, and what do they do?",{"text":118,"@type":114},"It focuses on glutamatergic, cholinergic, and GABAergic systems. These systems produce ligand-gated currents that collectively regulate automaticity, excitability, and conductivity in cardiomyocytes and atrioventricular node pacemaker cells.",{"name":120,"@type":111,"acceptedAnswer":121},"How does ETS disruption relate to arrhythmias?",{"text":122,"@type":114},"Disruption of these mechanisms can cause electrical instability and contribute to arrhythmias such as atrial fibrillation, atrioventricular block, and ventricular tachyarrhythmias.","https://schema.org",{"og:url":83,"og:type":125,"og:title":65,"og:site_name":95,"og:description":67},"article",{"robots":127,"canonical":83},"index,follow",{"doc_id":129,"site_id":62},449301,1790793274,{"code":4,"msg":5,"data":132},{"doc_id":129,"user_id":133,"nickname":92,"user_avatar":134,"doc_module":4,"category_id":34,"category_name":35,"doc_title":65,"doc_description":67,"doc_content":135,"file_id":136,"file_url":137,"file_type":138,"file_size":139,"view_count":105,"is_deleted":4,"is_public":8,"is_downloadable":8,"audit_status":8,"page_count":140,"language":141,"language_code":63,"site_id":62,"html_lang":63,"table_of_contents":142,"faqs":143,"seo_title":144,"seo_description":67,"update_tm":145,"read_time":146,"preview_page_count":4},2336478951081,"https://ap-avatar.wpscdn.com/davatar_276721f389ce27ea32af1340a28f341c","European Heart Journal (2026) 47, 188–198 [https://doi.org/10.1093/eurheartj/ehaf928](https://doi.org/10.1093/eurheartj/ehaf928)  \nSTATE OF THE ART REVIEW  \nArrhythmias  \nCardiac endogenous transmitter system: molecular features, functions, and clinical implications  \nDuanyang Xie1,2,†, Dandan Liang1,2,†, Liping Zhou1,2, Yi Liu1,2,  \nand Yi-Han Chen  1,2,*  \n1Department of Cardiology and State Key Laboratory of Cardiovascular Diseases, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China; and 2Shanghai Arrhythmia Research Center, Shanghai East Hospital, School of Medicine, Tongji University, Shanghai, China  \nReceived 3 March 2025; revised 6 May 2025; accepted 1 November 2025; online publish-ahead-of-print 19 November 2025  \nGraphical Abstract  \nEndogenous transmitter system of the heart  \nCardiac ETS  \nLigand-gated currents  \nCardiac bioelectrical homeostasis  \nCardiac ETS deficiency  \nAbnormal ligand-gated  \ncurrents  \nCardiac bioelectrical dyshomeostasis  \n ~~  Conductivity  ~~   \nStability of cardiac electrophysiological foundations  \nInstability of cardiac electrophysiological foundations  \nCardiac ETS  \nTransmitter metabolic enzymes, transmitter transporters, transmitter receptors  \nInterventions targeting cardiac ETS  \nETS  \nCardiac arrhythmias  \nETS  \nNormal heart rhythm  \nCardioversion  \n* Corresponding author. Email: [yihanchen@tongji.edu.cn](yihanchen@tongji.edu.cn)  \n† These authors contributed equally to this work.  \n© The Author(s) 2025. Published by Oxford University Press on behalf of the European Society of Cardiology.  \nThis is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License ([https://creativecommons.org/licenses/by-nc/4.0/](https://creativecommons.org/licenses/by-nc/4.0/)), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact [reprints@oup.com](reprints@oup.com) for reprints and translation rights for reprints. All other permissions can be obtained through our RightsLink service via the Permissions link on the article page on our site—for further information please contact [journals.permissions@oup.com](journals.permissions@oup.com).  \nThis review introduces a transmitter-based model of cardiac bioelectric regulation and proposes that endogenous transmitter systems in the heart constitute promising therapeutic targets for arrhythmia intervention. These systems, including the glutamatergic, cholinergic, and GABAergic systems, which produce ligand-gated currents in cardiomyocytes and atrioventricular node pacemaker cells, collectively regulate core electrophysiological properties such as automaticity, excitability, and conductivity. Disruption of these finely tuned mechanisms can lead to electrical instability and contribute to the onset of arrhythmias, including atrial fibrillation, atrioventricular block, and ventricular tachyarrhythmias. Importantly, key molecular components of these systems, such as transmitter-synthesizing enzymes, receptors, and transporters, can be pharmacologically targeted to restore electrical homeostasis and suppress arrhythmogenic activity. The identification of such transmitter-based signalling pathways in the heart fundamentally challenges the traditional view that cardiac conduction is mediated solely by ion channels and gap junctions. Instead, it reveals a previously underappreciated neurochemical dimension of cardiac regulation. By systematically presenting the molecular composition, electrophysiological roles, and clinical relevance of these systems, this review offers a new conceptual framework for understanding the mechanisms ofarrhythmogenesis and guiding future antiarrhythmic strategies.  \nAbstract  \nTransmitter systems are molecular networks that facilitate signal transmission between neurons or between neurons and effector cells. Well-established examples include the gluta","cbCair0zPc764PpE","https://ap.wps.com/l/cbCair0zPc764PpE","pdf",1928734,11,"English","# Introduction\n# Abstract\n# Keywords","[{\"question\":\"What is the endogenous transmitter system (ETS) concept in the heart?\",\"answer\":\"The review proposes that the heart contains endogenous transmitter systems within cardiomyocytes and cardiac pacemaker cells, enabling transmitter-based regulation of cardiac bioelectric properties.\"},{\"question\":\"Which transmitter systems are emphasized, and what do they do?\",\"answer\":\"It focuses on glutamatergic, cholinergic, and GABAergic systems. These systems produce ligand-gated currents that collectively regulate automaticity, excitability, and conductivity in cardiomyocytes and atrioventricular node pacemaker cells.\"},{\"question\":\"How does ETS disruption relate to arrhythmias?\",\"answer\":\"Disruption of these mechanisms can cause electrical instability and contribute to arrhythmias such as atrial fibrillation, atrioventricular block, and ventricular tachyarrhythmias.\"}]","Cardiac endogenous transmitter system: molecular features, functions, and clinical implications | PDF",1790729792,28]