The role of arrhythmogenic auditory stimuli in sudden cardiac death

A possible relation between auditory stimulation and susceptibility to ventricular fibrillation and sudden death emerges from review of clinical and pathologic studies. Evaluation of circumstances related to sudden cardiac death events revealed that there are numerous cases, either in young subjects with structurally normal hearts or in congenital anomalies involving the ear and heart such as the long QT syndrome, in which an auditory neural stimulus may induce lethal arrhythmia. A possible mechanism would be an auditory stimulus triggering an efferent pathway that arises in the hypothalamus and quadrigeminal bodies (which are an innervation site of the central auditory pathways), traverses the reticular formation, and is channeled via the stellate ganglia and the cardiac sympathetic nerves to the heart. In addition, since sudden noises may be alarming, they induce increased sympathetic activity, whether by neural or neurohumoral action, and predispose the heart to ventricular fibrillation even in the absence of any impaired coronary flow.