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Marrese A, Persico R, Parlato E, Faccenda D, Salucci A, Comparone G, Pergola V, Ammirati G, Addeo L, Fonderico C, Cocchiara L, Volpe A, Visconti P, Rapacciuolo A, Strisciuglio T. Cardioneuroablation: the known and the unknown. Front Cardiovasc Med 2024; 11:1412195. [PMID: 39131701 PMCID: PMC11310060 DOI: 10.3389/fcvm.2024.1412195] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2024] [Accepted: 06/28/2024] [Indexed: 08/13/2024] Open
Abstract
Cardioneuroablation (CNA) is a novel interventional procedure for the treatment of recurrent vasovagal syncope (VVS) and advanced atrioventricular block secondary to hyperactivation of vagal tone in young patients. By damaging the cardiac parasympathetic ganglia, CNA seems to be able to mitigate and/or abolish the excessive vagal activity and improve patients' outcome. This review is intended to give a detailed and comprehensive overview of the current evidences regarding (1) the clinical applications of CNA (2) the identification of ablation targets and procedural endpoints (3) the medium-long term effect of the procedure and its future perspectives. However, clinical data are still limited, and expert consensus or recommendations in the guidelines regarding this technique are still lacking.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - T. Strisciuglio
- Department of Cardiology, University of Naples Federico II, Naples, Italy
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2
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Tompkins JD, Hoover DB, Havton LA, Patel JC, Cho Y, Smith EH, Biscola NP, Ajijola OA, Shivkumar K, Ardell JL. Comparative specialization of intrinsic cardiac neurons in humans, mice, and pigs. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2024:2024.04.04.588174. [PMID: 38645175 PMCID: PMC11030249 DOI: 10.1101/2024.04.04.588174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/23/2024]
Abstract
Intrinsic cardiac neurons (ICNs) play a crucial role in the proper functioning of the heart; yet a paucity of data pertaining to human ICNs exists. We took a multidisciplinary approach to complete a detailed cellular comparison of the structure and function of ICNs from mice, pigs, and humans. Immunohistochemistry of whole and sectioned ganglia, transmission electron microscopy, intracellular microelectrode recording and dye filling for quantitative morphometry were used to define the neurophysiology, histochemistry, and ultrastructure of these cells across species. The densely packed, smaller ICNs of mouse lacked dendrites, formed axosomatic connections, and had high synaptic efficacy constituting an obligatory synapse. At Pig ICNs, a convergence of subthreshold cholinergic inputs onto extensive dendritic arbors supported greater summation and integration of synaptic input. Human ICNs were tonically firing, with synaptic stimulation evoking large suprathreshold excitatory postsynaptic potentials like mouse, and subthreshold potentials like pig. Ultrastructural examination of synaptic terminals revealed conserved architecture, yet small clear vesicles (SCVs) were larger in pigs and humans. The presence and localization of ganglionic neuropeptides was distinct, with abundant VIP observed in human but not pig or mouse ganglia, and little SP or CGRP in pig ganglia. Action potential waveforms were similar, but human ICNs had larger after-hyperpolarizations. Intrinsic excitability differed; 93% of human cells were tonic, all pig neurons were phasic, and both phasic and tonic phenotypes were observed in mouse. In combination, this publicly accessible, multimodal atlas of ICNs from mice, pigs, and humans identifies similarities and differences in the evolution of ICNs.
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Affiliation(s)
- John D. Tompkins
- UCLA Cardiac Arrhythmia Center and Neurocardiology Research Program of Excellence, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Donald B. Hoover
- Department of Biomedical Sciences, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Leif A. Havton
- Departments of Neuroscience, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Janaki C. Patel
- UCLA Cardiac Arrhythmia Center and Neurocardiology Research Program of Excellence, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Youngjin Cho
- UCLA Cardiac Arrhythmia Center and Neurocardiology Research Program of Excellence, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Elizabeth H. Smith
- Department of Biomedical Sciences, Quillen College of Medicine, East Tennessee State University, Johnson City, TN, USA
| | - Natalia P. Biscola
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Olujimi A. Ajijola
- UCLA Cardiac Arrhythmia Center and Neurocardiology Research Program of Excellence, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Kalyanam Shivkumar
- UCLA Cardiac Arrhythmia Center and Neurocardiology Research Program of Excellence, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
| | - Jeffrey L. Ardell
- UCLA Cardiac Arrhythmia Center and Neurocardiology Research Program of Excellence, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA
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Giannino G, Braia V, Griffith Brookles C, Giacobbe F, D'Ascenzo F, Angelini F, Saglietto A, De Ferrari GM, Dusi V. The Intrinsic Cardiac Nervous System: From Pathophysiology to Therapeutic Implications. BIOLOGY 2024; 13:105. [PMID: 38392323 PMCID: PMC10887082 DOI: 10.3390/biology13020105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/10/2024] [Revised: 02/02/2024] [Accepted: 02/05/2024] [Indexed: 02/24/2024]
Abstract
The cardiac autonomic nervous system (CANS) plays a pivotal role in cardiac homeostasis as well as in cardiac pathology. The first level of cardiac autonomic control, the intrinsic cardiac nervous system (ICNS), is located within the epicardial fat pads and is physically organized in ganglionated plexi (GPs). The ICNS system does not only contain parasympathetic cardiac efferent neurons, as long believed, but also afferent neurons and local circuit neurons. Thanks to its high degree of connectivity, combined with neuronal plasticity and memory capacity, the ICNS allows for a beat-to-beat control of all cardiac functions and responses as well as integration with extracardiac and higher centers for longer-term cardiovascular reflexes. The present review provides a detailed overview of the current knowledge of the bidirectional connection between the ICNS and the most studied cardiac pathologies/conditions (myocardial infarction, heart failure, arrhythmias and heart transplant) and the potential therapeutic implications. Indeed, GP modulation with efferent activity inhibition, differently achieved, has been studied for atrial fibrillation and functional bradyarrhythmias, while GP modulation with efferent activity stimulation has been evaluated for myocardial infarction, heart failure and ventricular arrhythmias. Electrical therapy has the unique potential to allow for both kinds of ICNS modulation while preserving the anatomical integrity of the system.
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Affiliation(s)
- Giuseppe Giannino
- Cardiology, Department of Medical Sciences, University of Turin, 10124 Torino, Italy
- Division of Cardiology, Cardiovascular and Thoracic Department, 'Città della Salute e della Scienza' Hospital, 10126 Torino, Italy
| | - Valentina Braia
- Cardiology, Department of Medical Sciences, University of Turin, 10124 Torino, Italy
- Division of Cardiology, Cardiovascular and Thoracic Department, 'Città della Salute e della Scienza' Hospital, 10126 Torino, Italy
| | - Carola Griffith Brookles
- Cardiology, Department of Medical Sciences, University of Turin, 10124 Torino, Italy
- Division of Cardiology, Cardiovascular and Thoracic Department, 'Città della Salute e della Scienza' Hospital, 10126 Torino, Italy
| | - Federico Giacobbe
- Cardiology, Department of Medical Sciences, University of Turin, 10124 Torino, Italy
- Division of Cardiology, Cardiovascular and Thoracic Department, 'Città della Salute e della Scienza' Hospital, 10126 Torino, Italy
| | - Fabrizio D'Ascenzo
- Cardiology, Department of Medical Sciences, University of Turin, 10124 Torino, Italy
- Division of Cardiology, Cardiovascular and Thoracic Department, 'Città della Salute e della Scienza' Hospital, 10126 Torino, Italy
| | - Filippo Angelini
- Division of Cardiology, Cardiovascular and Thoracic Department, 'Città della Salute e della Scienza' Hospital, 10126 Torino, Italy
| | - Andrea Saglietto
- Division of Cardiology, Cardiovascular and Thoracic Department, 'Città della Salute e della Scienza' Hospital, 10126 Torino, Italy
| | - Gaetano Maria De Ferrari
- Cardiology, Department of Medical Sciences, University of Turin, 10124 Torino, Italy
- Division of Cardiology, Cardiovascular and Thoracic Department, 'Città della Salute e della Scienza' Hospital, 10126 Torino, Italy
| | - Veronica Dusi
- Cardiology, Department of Medical Sciences, University of Turin, 10124 Torino, Italy
- Division of Cardiology, Cardiovascular and Thoracic Department, 'Città della Salute e della Scienza' Hospital, 10126 Torino, Italy
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Aksu T, Po SS. How to perform cardioneuroablation for vasovagal syncope and functional bradycardia. Heart Rhythm 2024; 21:100-105. [PMID: 37776935 DOI: 10.1016/j.hrthm.2023.09.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2023] [Revised: 09/21/2023] [Accepted: 09/21/2023] [Indexed: 10/02/2023]
Affiliation(s)
- Tolga Aksu
- Faculty of Medicine, Yeditepe University, Istanbul, Turkey.
| | - Sunny S Po
- University of Oklahoma Health Science Center, Oklahoma City, Oklahoma
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Pauziene N, Ranceviene D, Rysevaite-Kyguoliene K, Ragauskas T, Inokaitis H, Sabeckis I, Plekhanova K, Khmel O, Pauza DH. Neurochemical alterations of intrinsic cardiac ganglionated nerve plexus caused by arterial hypertension developed during ageing in spontaneously hypertensive and Wistar Kyoto rats. J Anat 2023; 243:630-647. [PMID: 37083051 PMCID: PMC10485580 DOI: 10.1111/joa.13877] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2023] [Revised: 03/28/2023] [Accepted: 03/30/2023] [Indexed: 04/22/2023] Open
Abstract
The acknowledged hypothesis of the cause of arterial hypertension is the emerging disbalance in sympathetic and parasympathetic regulations of the cardiovascular system. This disbalance manifests in a disorder of sustainability of endogenous autonomic and sensory neural substances including calcitonin gene-related peptide (CGRP). This study aimed to examine neurochemical alterations of intrinsic cardiac ganglionated nerve plexus (GP) triggered by arterial hypertension during ageing in spontaneously hypertensive rats of juvenile (prehypertensive, 8-9 weeks), adult (early hypertensive, 12-18 weeks) and elderly (persistent hypertensive, 46-60 weeks) age in comparison with the age-matched Wistar-Kyoto rats as controls. Parasympathetic, sympathetic and sensory neural structures of GP were analysed and evaluated morphometrically in tissue sections and whole-mount cardiac preparations. Both the elevated blood pressure and the evident ultrasonic signs of heart failure were identified for spontaneously hypertensive rats and in part for the aged control rats. The amount of adrenergic and immunoreactive to CGRP neural structures was increased in the adult group of spontaneously hypertensive rats along with the significant alterations that occurred during ageing. In conclusion, the revealed chemical alterations of GP support the hypothesis about the possible disbalance of efferent and afferent heart innervation and may be considered as the basis for the emergence and progression of arterial hypertension and perhaps even as a consequence of hypertension in the aged spontaneously hypertensive rats. The determined anatomical changes in the ageing Wistar-Kyoto rats suggest this breed being as inappropriate for its use as control animals for hypertension studies in older animal age.
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Affiliation(s)
- Neringa Pauziene
- Institute of Anatomy, Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Dalia Ranceviene
- Institute of Anatomy, Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Tomas Ragauskas
- Institute of Anatomy, Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Hermanas Inokaitis
- Institute of Anatomy, Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Ignas Sabeckis
- Institute of Anatomy, Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Khrystyna Plekhanova
- Institute of Anatomy, Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Olena Khmel
- Institute of Anatomy, Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Dainius H Pauza
- Institute of Anatomy, Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Saburkina I, Pauziene N, Solomon OI, Rysevaite-Kyguoliene K, Pauza DH. Comparative gross anatomy of epicardiac ganglionated nerve plexi on the human and sheep cardiac ventricles. Anat Rec (Hoboken) 2023; 306:2302-2312. [PMID: 36181389 DOI: 10.1002/ar.25085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 08/24/2022] [Accepted: 09/10/2022] [Indexed: 11/06/2022]
Abstract
This study aimed to examine the distribution and quantitative parameters of the epicardiac ventricular neural ganglionated plexus in the hearts of humans and sheep, highlighting the differences of this plexus in humans and large models. Five non-sectioned pressure distended whole hearts of the human newborns and 10 hearts of newborn German black-faced lambs were investigated applying a histochemical method for acetylcholinesterase to stain epicardiac neural structures with their subsequent stereomicroscopic examination. In humans, the ventricular nerves are spread by four epicardiac nerve subplexuses, that is, the left and right coronary as well as the left and middle dorsal. In sheep, the ventricular nerves are spread by five epicardiac nerve subplexuses, that is, the left and right coronary, the left and middle dorsal and the right ventral ones. The ventricular epicardium involved up to 129 ganglia in humans and up to 198-in sheep. The largest number of the ventricular ganglionic cells in humans were located on the ventral side, in front of the conus arteriosus, while on sheep ventricles, the most numerous neurons distributed on the dorsal wall of the left ventricle. This comparative study of the morphological patterns of the human and sheep ventricles demonstrates that the sheep heart is neuroanatomically distinct from the human one and this must be taking into consideration using the sheep model for the heart physiology experiments.
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Affiliation(s)
- Inga Saburkina
- Institute of Anatomy, Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Neringa Pauziene
- Institute of Anatomy, Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - On Itai Solomon
- Institute of Anatomy, Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Dainius H Pauza
- Institute of Anatomy, Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Intrinsic Cardiac Neuromodulation in the Management of Atrial Fibrillation- A Potential Missing Link? Life (Basel) 2023; 13:life13020383. [PMID: 36836740 PMCID: PMC9966489 DOI: 10.3390/life13020383] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2022] [Revised: 01/14/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023] Open
Abstract
Atrial fibrillation (AF) is the most common supraventricular arrhythmia that is linked with higher cardiovascular morbidity and mortality. Recent evidence has demonstrated that catheter-based pulmonary vein isolation (PVI) is not only a viable alternative but may be superior to antiarrhythmic drug therapy for long-term freedom from symptomatic AF episodes, a reduction in the arrhythmia burden, and healthcare resource utilization with a similar risk of adverse events. The intrinsic cardiac autonomic nervous system (ANS) has a significant influence on the structural and electrical milieu, and imbalances in the ANS may contribute to the arrhythmogenesis of AF in some individuals. There is now increasing scientific and clinical interest in various aspects of neuromodulation of intrinsic cardiac ANS, including mapping techniques, ablation methods, and patient selection. In the present review, we aimed to summarize and critically appraise the currently available evidence for the neuromodulation of intrinsic cardiac ANS in AF.
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Abstract
INTRODUCTION Cardioneuroablation is increasingly being utilized to improve outcomes in patients with vagally mediated bradyarrhythmias. However, there are still controversial issues in the field including patient selection, safety and efficacy, and procedural end-points. AREAS COVERED In this review, the current role of cardioneuroablation is summarized, and controversial issues related to the modality are discussed. EXPERT OPINION According to small open-label cohort studies, overall freedom from syncope recurrence was higher than 90% after cardioneuroablation in patients with vasovagal syncope (VVS). Use of the electrogram-based strategy or high-frequency stimulation demonstrate similar success rate except in procedures limited to the right atrium. Based on a recently published randomized controlled trial and metanalysis, it may be possible now to make a strong recommendation for cardioneuroablation in patients <40 years of age, and those with the cardioinhibitory or mixed type of VVS who continue to experience frequent and/or burdensome syncope recurrences. Considering patients with VVS are prone to significant placebo/expectation effect, sham-controlled trials may help to quantify the placebo effect. In well-selected patients with functional atrioventricular block and sinus bradycardia, may result in encouraging medium-term outcomes. However, functional bradycardia is identified in a minority of patients presenting with high-grade atrioventricular block or sinus node dysfunction.
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Affiliation(s)
- Tolga Aksu
- Department of Cardiology, Yeditepe University Hospital, Istanbul, Turkey
| | - Asad Khan
- Department of Cardiology, Rush Medical College, Chicago, IL, USA
| | - Henry Huang
- Department of Cardiology, Rush Medical College, Chicago, IL, USA
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Del Monte A, Pannone L, Bisignani A, Osório TG, Iacopino S, Chierchia GB, de Asmundis C. Cryoballoon ablation for atrial fibrillation: Effects on neuromodulation. Front Cardiovasc Med 2022; 9:958316. [PMID: 35966567 PMCID: PMC9366392 DOI: 10.3389/fcvm.2022.958316] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Accepted: 06/28/2022] [Indexed: 11/16/2022] Open
Abstract
Pulmonary vein isolation (PVI) represents the mainstay of atrial fibrillation (AF) ablation, and PVI with cryoballoon catheter (CB) ablation (CB-A) has proven to be as effective and safe as radiofrequency ablation (RF-A). Although AF is initiated by triggers arising from the pulmonary veins (PV) and non-PV foci, the intrinsic cardiac nervous system (ICNS) plays a significant role in the induction and maintenance of AF. The ICNS is an epicardial neural system composed of ganglionated plexi (GPs) and a complex network of interconnecting neurons. In the left atrium, the major GPs are located in proximity to the PV-left atrial junction. Vagal reactions have been described as markers of autonomic modulation during PVI with both RF-A and CB-A. The occurrence of neuromodulation during PVI with CB-A may be explained by both the anatomical relationship between the GPs and the PVs and the characteristics of the CB. Due to the CB/PV size mismatch, the CB creates a wide ablation area that extends from the PV ostium toward the antrum, possibly including the GPs. Although targeted GPs ablation, as a supplemental strategy to PVI, has been associated with a better AF outcome in patients undergoing RF-A, the additional clinical benefit of neuromodulation during PVI with CB-A remains a matter of debate. In this review, we provide an overview of the anatomy of the ICNS, the relationship between the ICNS and AF pathophysiology, and the current evidence on the clinical relevance of neuromodulation during PVI with CB-A.
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Affiliation(s)
- Alvise Del Monte
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Luigi Pannone
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Antonio Bisignani
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Thiago G. Osório
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
| | - Saverio Iacopino
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
- Arrhythmology Department, Maria Cecilia Hospital, Cotignola, Italy
| | - Gian-Battista Chierchia
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
- *Correspondence: Gian-Battista Chierchia
| | - Carlo de Asmundis
- Heart Rhythm Management Centre, Postgraduate Program in Cardiac Electrophysiology and Pacing, Universitair Ziekenhuis Brussel - Vrije Universiteit Brussel, European Reference Networks Guard-Heart, Brussels, Belgium
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Kuniewicz M, Karkowski G, Gosnell M, Goncerz G, Badacz R, Rajs T, Legutko J. Anatomical and electrophysiological localization of ganglionated plexi using high-density 3D CARTO mapping system. TRANSLATIONAL RESEARCH IN ANATOMY 2022. [DOI: 10.1016/j.tria.2022.100202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
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11
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Intrinsic cardiac neurons of the adult pigs: chemical types, abundance, parameters and distribution within ganglionated plexus. Ann Anat 2022; 243:151935. [DOI: 10.1016/j.aanat.2022.151935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2021] [Revised: 03/04/2022] [Accepted: 03/09/2022] [Indexed: 11/18/2022]
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Aksu T, Baysal E, Lakkireddy D, Yalin K, Gopinathannair R. Comparison of Fragmented Electrogram Based Strategy and High Frequency Stimulation for Detection of Ganglionated Plexi. J Atr Fibrillation 2021; 13:2440. [PMID: 34950325 DOI: 10.4022/jafib.2440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2020] [Revised: 07/14/2020] [Accepted: 07/28/2020] [Indexed: 11/10/2022]
Abstract
Ganglionated plexus (GP) ablation is an emerging technique in patients with cardioinhibitory vasovagal syncope and vagally mediated atrial fibrillation. Localization of GPs can be impacted by the technique used. A reproducible methodology for GP detection is needed to account for individual variations during electrophysiologic study. In this article, we aim to compare and contrast high-frequency stimulation vs. a fragmented electrogram guided strategy for GP localization.
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Affiliation(s)
- Tolga Aksu
- University of Health Sciences, Kocaeli Derince Training and Research Hospital, Department of Cardiology, Kocaeli, Turkey
| | - Erkan Baysal
- University of Health Sciences, Gazi Yaşargil Training and Research Hospital, Department of Cardiology, Diyarbakır, Turkey
| | | | - Kivanc Yalin
- Istanbul University-Cerrahpasa, Faculty of Medicine, Department of Cardiology, Istanbul, Turkey
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13
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Ragauskas T, Rysevaite-Kyguoliene K, Pauziene N, Inokaitis H, Pauza DH. Chemical phenotypes of intrinsic cardiac neurons in the newborn pig (Sus scrofa domesticus Erxleben, 1777). J Morphol 2021; 283:51-65. [PMID: 34727377 DOI: 10.1002/jmor.21426] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 09/28/2021] [Accepted: 10/30/2021] [Indexed: 11/12/2022]
Abstract
Intrinsic cardiac neurons (ICNs) are crucial cells in the neural regulation of heart rhythm, myocardial contractility, and coronary blood flow. ICNs exhibit diversity in their morphology and neurotransmitters that probably are age-dependent. Therefore, neuroanatomical heart studies have been currently focused on the identification of chemical phenotypes of ICNs to disclose their possible functions in heart neural regulation. Employing whole-mount immunohistochemistry, we examined ICNs from atria of the newborn pigs (Sus scrofa domesticus) as ICNs at this stage of development have never been neurochemically characterized so far. We found that the majority of the examined ICNs (>60%) were of cholinergic phenotype. Biphenotypic neuronal somata (NS), that is, simultaneously positive for two neuronal markers, were also rather common and distributed evenly within the sampled ganglia. Simultaneous positivity for cholinergic and adrenergic neuromarkers was specific in 16.4%, for cholinergic and nitrergic-in 3.5% of the examined NS. Purely either adrenergic or nitrergic ICNs were observed at 13% and 3.1%, correspondingly. Purely adrenergic and nitrergic NS were the most frequent in the ventral left atrial subplexus. Similarly to neuronal phenotype, sizes of NS also varied depending on the atrial region providing insights into their functional implications. Axons, but not NS, positive for classic sensory neuronal markers (vesicular glutamate transporter 2 and calcitonin gene-related peptide) were identified within epicardiac nerves and ganglia. Moreover, a substantial number of ICNs could not be attributed to any phenotype as they were not immunoreactive for antisera used in this study. Numerous dendrites with putative peptidergic and adrenergic contacts on cholinergic NS contributed to neuropil of ganglia. Our observations demonstrate that intrinsic cardiac ganglionated plexus is not fully developed in the newborn pig despite of dense network of neuronal processes and numerous signs of neural contacts within ganglia.
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Affiliation(s)
- Tomas Ragauskas
- Institute of Anatomy, Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | | | - Neringa Pauziene
- Institute of Anatomy, Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Hermanas Inokaitis
- Institute of Anatomy, Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
| | - Dainius Haroldas Pauza
- Institute of Anatomy, Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
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14
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Leung C, Robbins S, Moss A, Heal M, Osanlouy M, Christie R, Farahani N, Monteith C, Chen J, Hunter P, Tappan S, Vadigepalli R, Cheng Z(J, Schwaber JS. 3D single cell scale anatomical map of sex-dependent variability of the rat intrinsic cardiac nervous system. iScience 2021; 24:102795. [PMID: 34355144 PMCID: PMC8324857 DOI: 10.1016/j.isci.2021.102795] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 05/05/2021] [Accepted: 06/24/2021] [Indexed: 02/01/2023] Open
Abstract
We developed and analyzed a single cell scale anatomical map of the rat intrinsic cardiac nervous system (ICNS) across four male and three female hearts. We find the ICNS has a reliable structural organizational plan across individuals that provide the foundation for further analyses of the ICNS in cardiac function and disease. The distribution of the ICNS was evaluated by 3D visualization and data-driven clustering. The pattern, distribution, and clustering of ICNS neurons across all male and female rat hearts is highly conserved, demonstrating a coherent organizational plan where distinct clusters of neurons are consistently localized. Female hearts had fewer neurons, lower packing density, and slightly reduced distribution, but with identical localization. We registered the anatomical data from each heart to a geometric scaffold, normalizing their 3D coordinates for standardization of common anatomical planes and providing a path where multiple experimental results and data types can be integrated and compared.
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Affiliation(s)
- Clara Leung
- Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, FL, USA
| | - Shaina Robbins
- Daniel Baugh Institute of Functional Genomics/Computational Biology, Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Alison Moss
- Daniel Baugh Institute of Functional Genomics/Computational Biology, Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University, Philadelphia, PA, USA
| | | | - Mahyar Osanlouy
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | - Richard Christie
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | | | | | - Jin Chen
- Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, FL, USA
| | - Peter Hunter
- Auckland Bioengineering Institute, University of Auckland, Auckland, New Zealand
| | | | - Rajanikanth Vadigepalli
- Daniel Baugh Institute of Functional Genomics/Computational Biology, Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Zixi (Jack) Cheng
- Burnett School of Biomedical Sciences, College of Medicine, University of Central Florida, Orlando, FL, USA
| | - James S. Schwaber
- Daniel Baugh Institute of Functional Genomics/Computational Biology, Department of Pathology, Anatomy, and Cell Biology, Thomas Jefferson University, Philadelphia, PA, USA
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15
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Aksu T, Gopinathannair R, Gupta D, Pauza DH. Intrinsic cardiac autonomic nervous system: What do clinical electrophysiologists need to know about the "heart brain"? J Cardiovasc Electrophysiol 2021; 32:1737-1747. [PMID: 33928710 DOI: 10.1111/jce.15058] [Citation(s) in RCA: 28] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Accepted: 04/23/2021] [Indexed: 11/29/2022]
Abstract
It is increasingly recognized that the autonomic nervous system (ANS) is a major contributor in many cardiac arrhythmias. Cardiac ANS can be divided into extrinsic and intrinsic parts according to the course of nerve fibers and localization of ganglia and neuron bodies. Although the role of the extrinsic part has historically gained more attention, the intrinsic cardiac ANS may affect cardiac function independently as well as influence the effects of the extrinsic nerves. Catheter-based modulation of the intrinsic cardiac ANS is emerging as a novel therapy for the management of patients with brady and tachyarrhythmias resulting from hyperactive vagal activation. However, the distribution of intrinsic cardiac nerve plexus in the human heart and the functional properties of intrinsic cardiac neural elements remain insufficiently understood. The present review aims to bring the clinical and anatomical elements of the immune effector cell-associated neurotoxicity together, by reviewing neuroanatomical terminologies and physiological functions, to guide the clinical electrophysiologist in the catheter lab and to serve as a reference for further research.
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Affiliation(s)
- Tolga Aksu
- Department of Cardiology, Yeditepe University Hospital, Istanbul, Turkey
| | - Rakesh Gopinathannair
- Departments of Electrophysiology, Kansas City Heart Rhythm Institute and Research Foundation, Kansas City, Missouri, USA
| | - Dhiraj Gupta
- Department of Electrophysiology, Liverpool Heart and Chest Hospital, Liverpool, United Kingdom
| | - Dainius H Pauza
- Department of Anatomy, Lithuanian University of Health Sciences, Kaunas, Lithuania
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16
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17
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Aksu T, Bozyel S, Yalin K, Tanboga IH, Gopinathannair R. QTc shortening effect of ganglionated plexi ablation. J Cardiovasc Electrophysiol 2021; 32:1161-1165. [PMID: 33625749 DOI: 10.1111/jce.14969] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 02/13/2021] [Accepted: 02/18/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND In previous studies, patients undergoing ablation of ganglionated plexi (GPA) for vagally mediated bradyarrhythmias were noted to have shortening of their corrected QT interval (QTc). AIMS To compare the effects of GPA (group 1) to pulmonary vein isolation + GPA (group 2) on QTc. MATERIAL AND METHODS We enrolled 39 patients, n = 25 in group 1 and n = 14 in group 2. QTc was calculated at baseline, at 24 h after ablation, and at 9-12 months in the follow-up. Recurrent syncope, asystole >2 s, and/or second- or third-degree AVB episodes were carefully documented as the primary outcome in group 1. Any atrial arrhythmia ≥30 seconds documented on 24-h Holter monitoring was defined as the primary outcome in group 2. RESULTS The mean follow-up time was 14.9 ± 4 months. Acute success was achieved in all cases. In whole cohort, a significant shortening on QTcBazett, QTcFramingham, QTcFredericia, and QTcHodges was observed [416 vs 398ms (p = .002), 411vs 378 ms (p < .001), 412 vs 379ms (p < .001), and 420 vs 383ms (p < .001), respectively]. In the linear mixed model analysis, the longitudinal reduction tendency in the QTc level was more pronounced in group 1. Event-free survival was detected in 90.7% (59/65) of cases. DISCUSSION Our results demonstrate a significant shortening of QTc in addition to high medium-term success rates after GPA. Pulmonary vein isolation + GPA was associated with lower QTc shortening effect which implies structural disease may change electrophysiological response to ablation. The most likely mechanism is the effect of GPA on the sympathetic system.
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Affiliation(s)
- Tolga Aksu
- Department of Cardiology, Kocaeli Derince Training and Research Hospital, University of Health Sciences, Kocaeli, Turkey
| | - Serdar Bozyel
- Department of Cardiology, Kocaeli Derince Training and Research Hospital, University of Health Sciences, Kocaeli, Turkey
| | - Kivanc Yalin
- Department of Cardiology, Faculty of Medicine, Istanbul University-Cerrahpasa, Istanbul, Turkey
| | - Ibrahim H Tanboga
- Department of Cardiology, Nisantasi University & Hisar Intercontinental Hospital, Istanbul, Turkey
| | - Rakesh Gopinathannair
- Department of Electrophysiology, Kansas City Heart Rhythm Institute and Research Foundation, Overland Park, Kansas, USA
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18
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Jimenes DR, Teixeira Junior NR, Pereira AV, Berti JA, Barbosa CP, Sant'Ana DDMG. Human apoCIII transgenic mice with epicardial adipose tissue inflammation and PRESERVATION of the cardiac plexus. Exp Gerontol 2021; 148:111261. [PMID: 33647361 DOI: 10.1016/j.exger.2021.111261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2020] [Revised: 12/16/2020] [Accepted: 01/24/2021] [Indexed: 10/22/2022]
Abstract
Hypertriglyceridemia is a result of the increase in the serum levels of lipoproteins, which are responsible for the transport of triglycerides and can be caused by genetic and/or metabolic factors. Animal models which either express or lack genes related to changes in the lipoproteins profile are useful to understand lipid metabolism. Apolipoprotein CIII (apoCIII) is an important modulator of hepatic production and peripheral removal of triglycerides. Mice that overexpress the apoCIII gene become hypertriglyceridemic, showing high concentrations of free fatty acids in the blood. Since hypertriglyceridemia is related to atherosclerosis, and the latter refers to cardiac alterations, this study aimed at evaluating the morphological, morphometric and quantitative profiles of the cardiac plexus, as well as the morphometric and histopathological aspects of the epicardial adipose tissue in human apoCIII transgenic mice. Therefore, 8-12-month-old male C57BL/6 mice that overexpressed human apoCIII (CIII) and their respective controls were used. Our results showed that overexpression of human apoCIII did not modify morphological or quantitative parameters of cardiac plexus neurons; however, age increased both, the area and the number of such cells. Furthermore, there was a direct correlation of this dyslipidemia to the thickening of periganglionar type 1 collagens. On the other hand, this overexpression caused epicardial adipose tissue inflammation and an increase in the area of the adipocytes, thus, favoring the recruitment of inflammatory cells in this tissue. In conclusion, this overexpression is harmful since it is related to an increase in cardiac adiposity, as well as to a predisposition to an inflammatory environment in the epicardial fat and to the incidence of cardiovascular diseases.
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Affiliation(s)
- Diogo Rodrigues Jimenes
- Program of Graduate Studies in Bioscience and Physiopathology - State University of Maringá (PBF-UEM), Brazil.
| | | | | | | | | | - Débora de Mello Gonçales Sant'Ana
- Program of Graduate Studies in Bioscience and Physiopathology - State University of Maringá (PBF-UEM), Brazil; Department of Physiological Sciences (DFS-UEM), Brazil
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19
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Fedele L, Brand T. The Intrinsic Cardiac Nervous System and Its Role in Cardiac Pacemaking and Conduction. J Cardiovasc Dev Dis 2020; 7:jcdd7040054. [PMID: 33255284 PMCID: PMC7712215 DOI: 10.3390/jcdd7040054] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2020] [Revised: 11/19/2020] [Accepted: 11/20/2020] [Indexed: 12/11/2022] Open
Abstract
The cardiac autonomic nervous system (CANS) plays a key role for the regulation of cardiac activity with its dysregulation being involved in various heart diseases, such as cardiac arrhythmias. The CANS comprises the extrinsic and intrinsic innervation of the heart. The intrinsic cardiac nervous system (ICNS) includes the network of the intracardiac ganglia and interconnecting neurons. The cardiac ganglia contribute to the tight modulation of cardiac electrophysiology, working as a local hub integrating the inputs of the extrinsic innervation and the ICNS. A better understanding of the role of the ICNS for the modulation of the cardiac conduction system will be crucial for targeted therapies of various arrhythmias. We describe the embryonic development, anatomy, and physiology of the ICNS. By correlating the topography of the intracardiac neurons with what is known regarding their biophysical and neurochemical properties, we outline their physiological role in the control of pacemaker activity of the sinoatrial and atrioventricular nodes. We conclude by highlighting cardiac disorders with a putative involvement of the ICNS and outline open questions that need to be addressed in order to better understand the physiology and pathophysiology of the ICNS.
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Affiliation(s)
- Laura Fedele
- Correspondence: (L.F.); (T.B.); Tel.: +44-(0)-207-594-6531 (L.F.); +44-(0)-207-594-8744 (T.B.)
| | - Thomas Brand
- Correspondence: (L.F.); (T.B.); Tel.: +44-(0)-207-594-6531 (L.F.); +44-(0)-207-594-8744 (T.B.)
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20
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Ganglionated Plexi Ablation for the Treatment of Atrial Fibrillation. J Clin Med 2020; 9:jcm9103081. [PMID: 32987820 PMCID: PMC7598705 DOI: 10.3390/jcm9103081] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2020] [Revised: 09/15/2020] [Accepted: 09/23/2020] [Indexed: 01/11/2023] Open
Abstract
Atrial fibrillation (AF) is the most common type of cardiac arrhythmia and is associated with significant morbidity and mortality. The autonomic nervous system (ANS) plays an important role in the initiation and development of AF, causing alterations in atrial structure and electrophysiological defects. The intrinsic ANS of the heart consists of multiple ganglionated plexi (GP), commonly nestled in epicardial fat pads. These GPs contain both parasympathetic and sympathetic afferent and efferent neuronal circuits that control the electrophysiological properties of the myocardium. Pulmonary vein isolation and other cardiac catheter ablation targets including GP ablation can disrupt the fibers connecting GPs or directly damage the GPs, mediating the benefits of the ablation procedure. Ablation of GPs has been evaluated over the past decade as an adjunctive procedure for the treatment of patients suffering from AF. The success rate of GP ablation is strongly associated with specific ablation sites, surgical techniques, localization techniques, method of access and the incorporation of additional interventions. In this review, we present the current data on the clinical utility of GP ablation and its significance in AF elimination and the restoration of normal sinus rhythm in humans.
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21
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Yildiz M, Kahraman S, Kafali HC, Surgit O, Ergul Y. An unusual treatment of coronary injury following radiofrequency ablation in a 5-year-old child: Systemic steroid usage. PACING AND CLINICAL ELECTROPHYSIOLOGY: PACE 2020; 43:1404-1407. [PMID: 32543718 DOI: 10.1111/pace.13986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 06/01/2020] [Accepted: 06/14/2020] [Indexed: 11/29/2022]
Abstract
Radiofrequency catheter ablation (RFCA) procedure is performed for many tachyarrhythmias. We performed successful RFCA in a 5-year-old child for supraventricular tachyarrhythmia and Wolff-Parkinson-White syndrome. Acute circumflex artery (CxA) occlusion occurred due to RFCA. After percutaneous balloon angioplasty was performed into the CxA, the patient was treated with systemic steroid to resolve myocardial edema. To the best of our knowledge, systemic steroid was used first time for acute coronary artery injury related myocardial ischemia.
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Affiliation(s)
- Mustafa Yildiz
- Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Department of Cardiology, University of Health Sciences, Istanbul, Turkey
| | - Serkan Kahraman
- Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Department of Cardiology, University of Health Sciences, Istanbul, Turkey
| | - Hasan Candas Kafali
- Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Department of Pediatric Cardiology/Electrophysiology, University of Health Sciences, Istanbul, Turkey
| | - Ozgur Surgit
- Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Department of Cardiology, University of Health Sciences, Istanbul, Turkey
| | - Yakup Ergul
- Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Center, Training and Research Hospital, Department of Pediatric Cardiology/Electrophysiology, University of Health Sciences, Istanbul, Turkey
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22
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Pachon-M EI, Pachon-Mateos JC, Higuti C, Santillana-P TG, Lobo T, Pachon C, Pachon-Mateos J, Zerpa J, Ortencio F, Amarante RC, Silva RF, Osório TG. Relation of Fractionated Atrial Potentials With the Vagal Innervation Evaluated by Extracardiac Vagal Stimulation During Cardioneuroablation. Circ Arrhythm Electrophysiol 2020; 13:e007900. [PMID: 32188285 DOI: 10.1161/circep.119.007900] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Vagal hyperactivity is directly related to several clinical conditions as reflex/functional bradyarrhythmias and vagal atrial fibrillation (AF). Cardioneuroablation provides therapeutic vagal denervation through endocardial radiofrequency ablation for these cases. The main challenges are neuromyocardium interface identification and the denervation control and validation. The finding that the AF-Nest (AFN) ablation eliminates the atropine response and decreases RR variability suggests that they are related to the vagal innervation. METHOD Prospective, controlled, longitudinal, nonrandomized study enrolling 62 patients in 2 groups: AFN group (AFN group 32 patients) with functional or reflex bradyarrhythmias or vagal AF treated with AFN ablation and a control group (30 patients) with anomalous bundles, ventricular premature beats, atrial flutter, atrioventricular nodal reentry, and atrial tachycardia, treated with conventional ablation (non-AFN ablation). In AFN group, ablation delivered at AFN detected by fragmentation/fractionation of the endocardial electrograms and by 3-dimensional anatomic location of the ganglionated plexus. Vagal response was evaluated before, during, and postablation by 5 s noncontact vagal stimulation at the jugular foramen, through the internal jugular veins (extracardiac vagal stimulation [ECVS]), analyzing 15 s mean heart rate, longest RR, pauses, and atrioventricular block. All patients had current guidelines arrhythmia ablation indication. RESULTS Preablation ECVS induced sinus pauses, asystole, and transient atrioventricular block in both groups showing a strong vagal response (P=0.96). Postablation ECVS in the AFN group showed complete abolishment of the cardiac vagal response in all cases (pre/postablation ECVS=P<0.0001), demonstrating robust vagal denervation. However, in the control group, vagal response remained practically unchanged postablation (P=0.35), showing that non-AFN ablation promotes no significant denervation. CONCLUSIONS AFN ablation causes significant vagal denervation. Non-AFN ablation causes no significant vagal denervation. These results suggest that AFNs are intrinsically related to vagal innervation. ECVS was fundamental to stepwise vagal denervation validation during cardioneuroablation. Visual Overview A visual overview is available for this article.
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Affiliation(s)
- Enrique I Pachon-M
- Sao Paulo University, Brazil (E.I.P.-M., J.C.P.-M., J.P.-M., R.C.A.).,Heart Hospital, Sao Paulo, Brazil (E.I.P.-M., J.C.P.-M., C.H., T.G.S-P., T.L., C.P., J.P.-M., J.Z.,F.O., R.F.S, R.C.A.).,Dante Pazzanese Cardiology Institute, Sao Paulo, Brazil (J.C.P.-M., C.H., J.P.-M., R.C.A., R.F.S.). Brussels Universiteit, Belgium (T.G.O)
| | - Jose Carlos Pachon-Mateos
- Sao Paulo University, Brazil (E.I.P.-M., J.C.P.-M., J.P.-M., R.C.A.).,Heart Hospital, Sao Paulo, Brazil (E.I.P.-M., J.C.P.-M., C.H., T.G.S-P., T.L., C.P., J.P.-M., J.Z.,F.O., R.F.S, R.C.A.)
| | - Christian Higuti
- Heart Hospital, Sao Paulo, Brazil (E.I.P.-M., J.C.P.-M., C.H., T.G.S-P., T.L., C.P., J.P.-M., J.Z.,F.O., R.F.S, R.C.A.).,Dante Pazzanese Cardiology Institute, Sao Paulo, Brazil (J.C.P.-M., C.H., J.P.-M., R.C.A., R.F.S.). Brussels Universiteit, Belgium (T.G.O)
| | - Tomas G Santillana-P
- Heart Hospital, Sao Paulo, Brazil (E.I.P.-M., J.C.P.-M., C.H., T.G.S-P., T.L., C.P., J.P.-M., J.Z.,F.O., R.F.S, R.C.A.)
| | - Tasso Lobo
- Heart Hospital, Sao Paulo, Brazil (E.I.P.-M., J.C.P.-M., C.H., T.G.S-P., T.L., C.P., J.P.-M., J.Z.,F.O., R.F.S, R.C.A.)
| | - Carlos Pachon
- Heart Hospital, Sao Paulo, Brazil (E.I.P.-M., J.C.P.-M., C.H., T.G.S-P., T.L., C.P., J.P.-M., J.Z.,F.O., R.F.S, R.C.A.)
| | - Juan Pachon-Mateos
- Sao Paulo University, Brazil (E.I.P.-M., J.C.P.-M., J.P.-M., R.C.A.).,Heart Hospital, Sao Paulo, Brazil (E.I.P.-M., J.C.P.-M., C.H., T.G.S-P., T.L., C.P., J.P.-M., J.Z.,F.O., R.F.S, R.C.A.).,Dante Pazzanese Cardiology Institute, Sao Paulo, Brazil (J.C.P.-M., C.H., J.P.-M., R.C.A., R.F.S.). Brussels Universiteit, Belgium (T.G.O)
| | - Juan Zerpa
- Heart Hospital, Sao Paulo, Brazil (E.I.P.-M., J.C.P.-M., C.H., T.G.S-P., T.L., C.P., J.P.-M., J.Z.,F.O., R.F.S, R.C.A.)
| | - Felipe Ortencio
- Heart Hospital, Sao Paulo, Brazil (E.I.P.-M., J.C.P.-M., C.H., T.G.S-P., T.L., C.P., J.P.-M., J.Z.,F.O., R.F.S, R.C.A.)
| | - Ricardo Carneiro Amarante
- Sao Paulo University, Brazil (E.I.P.-M., J.C.P.-M., J.P.-M., R.C.A.).,Heart Hospital, Sao Paulo, Brazil (E.I.P.-M., J.C.P.-M., C.H., T.G.S-P., T.L., C.P., J.P.-M., J.Z.,F.O., R.F.S, R.C.A.).,Dante Pazzanese Cardiology Institute, Sao Paulo, Brazil (J.C.P.-M., C.H., J.P.-M., R.C.A., R.F.S.). Brussels Universiteit, Belgium (T.G.O)
| | - Ricardo Ferreira Silva
- Heart Hospital, Sao Paulo, Brazil (E.I.P.-M., J.C.P.-M., C.H., T.G.S-P., T.L., C.P., J.P.-M., J.Z.,F.O., R.F.S, R.C.A.).,Dante Pazzanese Cardiology Institute, Sao Paulo, Brazil (J.C.P.-M., C.H., J.P.-M., R.C.A., R.F.S.). Brussels Universiteit, Belgium (T.G.O)
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23
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The autonomic nervous system and cardiac arrhythmias: current concepts and emerging therapies. Nat Rev Cardiol 2019; 16:707-726. [DOI: 10.1038/s41569-019-0221-2] [Citation(s) in RCA: 77] [Impact Index Per Article: 15.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/07/2019] [Indexed: 12/19/2022]
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24
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Grandi E, Ripplinger CM. Antiarrhythmic mechanisms of beta blocker therapy. Pharmacol Res 2019; 146:104274. [PMID: 31100336 DOI: 10.1016/j.phrs.2019.104274] [Citation(s) in RCA: 39] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2019] [Revised: 05/04/2019] [Accepted: 05/13/2019] [Indexed: 02/07/2023]
Abstract
Sympathetic activity plays an important role in modulation of cardiac rhythm. Indeed, while exerting positive tropic effects in response to physiologic and pathologic stressors, β-adrenergic stimulation influences cardiac electrophysiology and can lead to disturbances of the heart rhythm and potentially lethal arrhythmias, particularly in pathological settings. For this reason, β-blockers are widely utilized clinically as antiarrhythmics. In this review, the molecular mechanisms of β-adrenergic action in the heart, the cellular and tissue level cardiac responses to β-adrenergic stimulation, and the clinical use of β-blockers as antiarrhythmic agents are reviewed. We emphasize the complex interaction between cardiomyocyte signaling, contraction, and electrophysiology occurring over multiple time- and spatial-scales during pathophysiological responses to β-adrenergic stimulation. An integrated understanding of this complex system is essential for optimizing therapies aimed at preventing arrhythmias.
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Affiliation(s)
- Eleonora Grandi
- Department of Pharmacology, University of California Davis, United States.
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25
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Neurokinin-3 receptor activation selectively prolongs atrial refractoriness by inhibition of a background K + channel. Nat Commun 2018; 9:4357. [PMID: 30341287 PMCID: PMC6195571 DOI: 10.1038/s41467-018-06530-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2017] [Accepted: 09/07/2018] [Indexed: 11/29/2022] Open
Abstract
The cardiac autonomic nervous system (ANS) controls normal atrial electrical function. The cardiac ANS produces various neuropeptides, among which the neurokinins, whose actions on atrial electrophysiology are largely unknown. We here demonstrate that the neurokinin substance-P (Sub-P) activates a neurokinin-3 receptor (NK-3R) in rabbit, prolonging action potential (AP) duration through inhibition of a background potassium current. In contrast, ventricular AP duration was unaffected by NK-3R activation. NK-3R stimulation lengthened atrial repolarization in intact rabbit hearts and consequently suppressed arrhythmia duration and occurrence in a rabbit isolated heart model of atrial fibrillation (AF). In human atrial appendages, the phenomenon of NK-3R mediated lengthening of atrial repolarization was also observed. Our findings thus uncover a pathway to selectively modulate atrial AP duration by activation of a hitherto unidentified neurokinin-3 receptor in the membrane of atrial myocytes. NK-3R stimulation may therefore represent an anti-arrhythmic concept to suppress re-entry-based atrial tachyarrhythmias, including AF. The cardiac autonomic nervous system produces various neuropeptides, such as neurokinin substance-P (Sub-P), whose function remains largely unclear. Here, authors show that Sub-P causes a receptor-mediated prolongation of the atrial action potential through a reduced background potassium current, and prevents atrial fibrillation.
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26
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Kodirov SA, Psyrakis D, Brachmann J, Zhuravlev VL. Limulus and heart rhythm. JOURNAL OF EXPERIMENTAL ZOOLOGY PART 2018; 331:61-79. [PMID: 30251467 DOI: 10.1002/jez.2235] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 08/24/2018] [Accepted: 08/28/2018] [Indexed: 01/08/2023]
Abstract
Great interest in the comparative physiology of hearts and their functions in Animalia has emerged with classic papers on Limulus polyphemus and mollusks. The recurrent cardiac activity-heart rate-is the most important physiological parameter and when present the kardia (Greek) is vital to the development of entire organs of the organisms in the animal kingdom. Extensive studies devoted to the regulation of cardiac rhythm in invertebrates have revealed that the basics of heart physiology are comparable to mammals. The hearts of invertebrates also beat spontaneously and are supplied with regulatory nerves: either excitatory or inhibitory or both. The distinct nerves and the source of excitation/inhibition at the level of single neurons are described for many invertebrate genera. The vertebrates and a majority of invertebrates have myogenic hearts, whereas the horseshoe crab L. polyphemus and a few other animals have a neurogenic cardiac rhythm. Nevertheless, the myogenic nature of heartbeat is precursor, because the contraction of native and stem-cell-derived cardiomyocytes does occur in the absence of any neural elements. Even in L. polyphemus, the heart rhythm is myogenic at embryonic stages.
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Affiliation(s)
- Sodikdjon A Kodirov
- Department of General Physiology, Saint Petersburg University, Saint Petersburg, Russia.,Department of Neurobiology, Neuroscience Institute, Morehouse School of Medicine, Atlanta, Georgia.,Department of Molecular Biology and Genetics, Almazov Federal Heart, Blood and Endocrinology Centre, Saint Petersburg, Russia.,Laboratory of Emotions' Neurobiology, Nencki Institute of Experimental Biology, Polish Academy of Sciences, Warsaw, Poland.,Department of Cardiology, University Hospital, Heidelberg, Germany
| | - Dimitrios Psyrakis
- Department of Cardiology and Angiology I, Heart Center Freiburg University, Freiburg, Germany
| | - Johannes Brachmann
- Department of Cardiology, Klinikum Coburg, Teaching Hospital of the University of Würzburg, Coburg, Germany.,Department of Cardiology, University Hospital, Heidelberg, Germany
| | - Vladimir L Zhuravlev
- Department of General Physiology, Saint Petersburg University, Saint Petersburg, Russia.,Department of Cardiology, University Hospital, Heidelberg, Germany
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27
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Lee SR, Cho Y, Cha MJ, Choi EK, Seo JW, Oh S. Atrial Innervation Patterns of Intrinsic Cardiac Autonomic Nerves. J Korean Med Sci 2018; 33:e253. [PMID: 30250413 PMCID: PMC6146147 DOI: 10.3346/jkms.2018.33.e253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2017] [Accepted: 06/26/2018] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Although ganglionated plexi (GPs) are important in the pathogenesis of arrhythmia, their patterns of atrial innervation have remained unclear. We investigated patterns of GP innervation to cardiac atria and the neuroanatomical interconnections among GPs in an animal model. METHODS Atrial innervation by GPs was evaluated in 10 mongrel dogs using a retrograde neuronal tracer (cholera toxin subunit B [CTB] conjugated with fluorescent dyes). In Experiment 1, CTB was injected into the atria. In Experiment 2, CTB was injected into the major GP, including the anterior right GP (ARGP), inferior right GP (IRGP), superior left GP (SLGP), and ligament of Marshall (LOM). After 7 days, the GPs were examined for the presence of tracer-positive neurons. RESULTS GPs in either right or left-side were innervating to both the same and opposite sides of the atrium. In quantitative analysis, right-sided GPs, especially ARGP, showed numerical predominance in atrial innervation. Based on the proportion of CTB-labeled ganglion in each GP, atrial innervation by GPs showed a tendency of laterality. In Experiment 2, CTB that was injected to a particular GP widely distributed in different GP. ARGP projected the largest number of innervating neurons to the IRGP, SLGP and LOM. CONCLUSION This study demonstrated that GPs project axons widely to both the same and opposite sides of atria. ARGP played a dominant role in atrial innervation. Furthermore, there were numerous neuroanatomical interconnections among GPs. These findings about neuronal innervation and interconnections of GPs could offer useful information for understanding intrinsic cardiac nervous system neuroanatomy.
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Affiliation(s)
- So-Ryoung Lee
- Department of Internal Medicine, Soonchunhyang University Seoul Hospital, Seoul, Korea
| | - Youngjin Cho
- Department of Cardiology, Cardiovascular Center, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Myung-jin Cha
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
| | - Jeong-Wook Seo
- Department of Pathology, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seil Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea
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Hanna P, Rajendran PS, Ajijola OA, Vaseghi M, Andrew Armour J, Ardell JL, Shivkumar K. Cardiac neuroanatomy - Imaging nerves to define functional control. Auton Neurosci 2017; 207:48-58. [PMID: 28802636 DOI: 10.1016/j.autneu.2017.07.008] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 07/22/2017] [Accepted: 07/28/2017] [Indexed: 01/08/2023]
Abstract
The autonomic nervous system regulates normal cardiovascular function and plays a critical role in the pathophysiology of cardiovascular disease. Further understanding of the interplay between the autonomic nervous system and cardiovascular system holds promise for the development of neuroscience-based cardiovascular therapeutics. To this end, techniques to image myocardial innervation will help provide a basis for understanding the fundamental underpinnings of cardiac neural control. In this review, we detail the evolution of gross and microscopic anatomical studies for functional mapping of cardiac neuroanatomy.
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Affiliation(s)
- Peter Hanna
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center and Neurocardiology Research Center of Excellence, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Pradeep S Rajendran
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center and Neurocardiology Research Center of Excellence, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA; Molecular, Cellular & Integrative Physiology Program, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Olujimi A Ajijola
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center and Neurocardiology Research Center of Excellence, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Marmar Vaseghi
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center and Neurocardiology Research Center of Excellence, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - J Andrew Armour
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center and Neurocardiology Research Center of Excellence, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Jefrrey L Ardell
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center and Neurocardiology Research Center of Excellence, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA; Molecular, Cellular & Integrative Physiology Program, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA
| | - Kalyanam Shivkumar
- University of California Los Angeles (UCLA) Cardiac Arrhythmia Center and Neurocardiology Research Center of Excellence, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA; Molecular, Cellular & Integrative Physiology Program, David Geffen School of Medicine, UCLA, Los Angeles, CA, USA.
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Pauziene N, Rysevaite-Kyguoliene K, Alaburda P, Pauza AG, Skukauskaite M, Masaityte A, Laucaityte G, Saburkina I, Inokaitis H, Plisiene J, Pauza DH. Neuroanatomy of the Pig Cardiac Ventricles. A Stereomicroscopic, Confocal and Electron Microscope Study. Anat Rec (Hoboken) 2017; 300:1756-1780. [DOI: 10.1002/ar.23619] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 03/10/2017] [Accepted: 03/15/2017] [Indexed: 12/31/2022]
Affiliation(s)
- Neringa Pauziene
- Institute of Anatomy; Faculty of Medicine, Lithuanian University of Health Sciences; Kaunas Lithuania
| | | | - Paulius Alaburda
- Institute of Anatomy; Faculty of Medicine, Lithuanian University of Health Sciences; Kaunas Lithuania
| | - Audrys G. Pauza
- Institute of Anatomy; Faculty of Medicine, Lithuanian University of Health Sciences; Kaunas Lithuania
| | - Monika Skukauskaite
- Institute of Anatomy; Faculty of Medicine, Lithuanian University of Health Sciences; Kaunas Lithuania
| | - Aiste Masaityte
- Institute of Anatomy; Faculty of Medicine, Lithuanian University of Health Sciences; Kaunas Lithuania
| | - Goda Laucaityte
- Institute of Anatomy; Faculty of Medicine, Lithuanian University of Health Sciences; Kaunas Lithuania
| | - Inga Saburkina
- Institute of Anatomy; Faculty of Medicine, Lithuanian University of Health Sciences; Kaunas Lithuania
| | - Hermanas Inokaitis
- Institute of Anatomy; Faculty of Medicine, Lithuanian University of Health Sciences; Kaunas Lithuania
| | - Jurgita Plisiene
- Institute of Anatomy; Faculty of Medicine, Lithuanian University of Health Sciences; Kaunas Lithuania
| | - Dainius H. Pauza
- Institute of Anatomy; Faculty of Medicine, Lithuanian University of Health Sciences; Kaunas Lithuania
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Delfiner MS, Siano J, Li Y, Dedkov EI, Zhang Y. Reduced epicardial vagal nerve density and impaired vagal control in a rat myocardial infarction-heart failure model. Cardiovasc Pathol 2016; 26:21-29. [PMID: 27852001 DOI: 10.1016/j.carpath.2016.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 10/07/2016] [Accepted: 10/17/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Autonomic remodeling, characterized by sympathetic activation and vagal withdrawal, contributes to heart failure (HF) progression. However, the exact mechanism(s) responsible for vagal withdrawal in HF remain(s) unclear, and whether HF causes epicardial autonomic nerve remodeling is unknown. METHODS AND RESULTS Myocardial infarction (MI) was produced in 14 Sprague-Dawley rats, and 10 sham surgery rats served as the control. MI-HF was confirmed 2 months after the surgery by echocardiography and hemodynamic measurement. Cervical vagal nerve stimulation was delivered to examine the heart rate slowing effect. Whole heart acetylcholinesterase histochemistry was used to examine the epicardial autonomic nerve remodeling at dorsal ventricles (remote from the infarcted area). Compared with the control animals, the same vagal nerve stimulation had less heart rate slowing effect in MI-HF group. Both epicardial nerve bundle length-density (2.56±0.60 μm/mm2 versus 1.68±0.46 μm/mm2, P=.001) and branching point-density (1.24±0.25 points/mm2 versus 0.66±0.18 points/mm2, P<.001) were lower in MI-HF rats. The chemically stained epicardial nerve bundles contain both sympathetic (tyrosine hydroxylase positive) and vagal (choline acetyltransferase positive) fibers. However, within the stained nerve bundle, the chemical color corresponds mainly with the vagal fibers. CONCLUSIONS Whole heart acetylcholinesterase histochemistry revealed a decreased ventricular epicardial vagal nerve density in MI-HF rats, which may contribute to impaired cardiac vagal control in HF.
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Affiliation(s)
- Matthew S Delfiner
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, USA
| | - John Siano
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, USA
| | - Ying Li
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, USA
| | - Eduard I Dedkov
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, USA
| | - Youhua Zhang
- Department of Biomedical Sciences, New York Institute of Technology College of Osteopathic Medicine, Old Westbury, NY, USA.
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31
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Kalla M, Herring N, Paterson DJ. Cardiac sympatho-vagal balance and ventricular arrhythmia. Auton Neurosci 2016; 199:29-37. [PMID: 27590099 PMCID: PMC5334443 DOI: 10.1016/j.autneu.2016.08.016] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Revised: 08/24/2016] [Accepted: 08/25/2016] [Indexed: 12/11/2022]
Abstract
A hallmark of cardiovascular disease is cardiac autonomic dysregulation. The phenotype of impaired parasympathetic responsiveness and sympathetic hyperactivity in experimental animal models is also well documented in large scale human studies in the setting of heart failure and myocardial infarction, and is predictive of morbidity and mortality. Despite advances in emergency revascularisation strategies for myocardial infarction, device therapy for heart failure and secondary prevention pharmacotherapies, mortality from malignant ventricular arrhythmia remains high. Patients at highest risk or those with haemodynamically significant ventricular arrhythmia can be treated with catheter ablation and implantable cardioverter defibrillators, but the morbidity and reduction in quality of life due to the burden of ventricular arrhythmia and shock therapy persists. Therefore, future therapies must aim to target the underlying pathophysiology that contributes to the generation of ventricular arrhythmia. This review explores recent advances in mechanistic research in both limbs of the autonomic nervous system and potential avenues for translation into clinical therapy. In addition, we also discuss the relationship of these findings in the context of the reported efficacy of current neuromodulatory strategies in the management of ventricular arrhythmia. We review advances in mechanistic research in the cardiac autonomic nervous system. This is discussed in relation to neuromodulatory therapy for ventricular arrhythmia. Neuromodulation therapies can influence both neurotransmitters and co-transmitters. This may therefore improve on conventional medical treatment.
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Affiliation(s)
| | - Neil Herring
- Corresponding author at: Burdon Sanderson Cardiac Science Centre, Dept. of Physiology, Anatomy and Genetics, University of Oxford, Parks Road, OX13PT, UK.Burdon Sanderson Cardiac Science CentreDept. of Physiology, Anatomy and GeneticsUniversity of OxfordParks RoadOX13PTUK
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Wang T, Miller KE. Characterization of glutamatergic neurons in the rat atrial intrinsic cardiac ganglia that project to the cardiac ventricular wall. Neuroscience 2016; 329:134-50. [PMID: 27167082 PMCID: PMC5922425 DOI: 10.1016/j.neuroscience.2016.05.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 04/29/2016] [Accepted: 05/03/2016] [Indexed: 12/20/2022]
Abstract
The intrinsic cardiac nervous system modulates cardiac function by acting as an integration site for regulating autonomic efferent cardiac output. This intrinsic system is proposed to be composed of a short cardio-cardiac feedback control loop within the cardiac innervation hierarchy. For example, electrophysiological studies have postulated the presence of sensory neurons in intrinsic cardiac ganglia (ICG) for regional cardiac control. There is still a knowledge gap, however, about the anatomical location and neurochemical phenotype of sensory neurons inside ICG. In the present study, rat ICG neurons were characterized neurochemically with immunohistochemistry using glutamatergic markers: vesicular glutamate transporters 1 and 2 (VGLUT1; VGLUT2), and glutaminase (GLS), the enzyme essential for glutamate production. Glutamatergic neurons (VGLUT1/VGLUT2/GLS) in the ICG that have axons to the ventricles were identified by retrograde tracing of wheat germ agglutinin-horseradish peroxidase (WGA-HRP) injected in the ventricular wall. Co-labeling of VGLUT1, VGLUT2, and GLS with the vesicular acetylcholine transporter (VAChT) was used to evaluate the relationship between post-ganglionic autonomic neurons and glutamatergic neurons. Sequential labeling of VGLUT1 and VGLUT2 in adjacent tissue sections was used to evaluate the co-localization of VGLUT1 and VGLUT2 in ICG neurons. Our studies yielded the following results: (1) ICG contain glutamatergic neurons with GLS for glutamate production and VGLUT1 and 2 for transport of glutamate into synaptic vesicles; (2) atrial ICG contain neurons that project to ventricle walls and these neurons are glutamatergic; (3) many glutamatergic ICG neurons also were cholinergic, expressing VAChT; (4) VGLUT1 and VGLUT2 co-localization occurred in ICG neurons with variation of their protein expression level. Investigation of both glutamatergic and cholinergic ICG neurons could help in better understanding the function of the intrinsic cardiac nervous system.
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Affiliation(s)
- Ting Wang
- Department of Anatomy and Cell Biology, Oklahoma State University Center for Health Sciences, Tulsa, OK 74107, United States
| | - Kenneth E Miller
- Department of Anatomy and Cell Biology, Oklahoma State University Center for Health Sciences, Tulsa, OK 74107, United States.
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33
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Wake E, Brack K. Characterization of the intrinsic cardiac nervous system. Auton Neurosci 2016; 199:3-16. [DOI: 10.1016/j.autneu.2016.08.006] [Citation(s) in RCA: 52] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 06/29/2016] [Accepted: 08/03/2016] [Indexed: 11/29/2022]
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Ripplinger CM, Noujaim SF, Linz D. The nervous heart. PROGRESS IN BIOPHYSICS AND MOLECULAR BIOLOGY 2016; 120:199-209. [PMID: 26780507 DOI: 10.1016/j.pbiomolbio.2015.12.015] [Citation(s) in RCA: 42] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/17/2015] [Revised: 12/29/2015] [Accepted: 12/31/2015] [Indexed: 12/23/2022]
Abstract
Many cardiac electrophysiological abnormalities are accompanied by autonomic nervous system dysfunction. Here, we review mechanisms by which the cardiac nervous system controls normal and abnormal excitability and may contribute to atrial and ventricular tachyarrhythmias. Moreover, we explore the potential antiarrhythmic and/or arrhythmogenic effects of modulating the autonomic nervous system by several strategies, including ganglionated plexi ablation, vagal and spinal cord stimulations, and renal sympathetic denervation as therapies for atrial and ventricular arrhythmias.
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Affiliation(s)
- Crystal M Ripplinger
- Department of Pharmacology, University of California Davis, 451 Health Sciences Drive, Davis, CA 95616, USA.
| | - Sami F Noujaim
- Molecular Pharmacology and Physiology, University of South Florida, 12901 Bruce B Downs Blvd, Tampa, FL 33612, USA.
| | - Dominik Linz
- Klinik für Innere Medizin III, Universitätsklinikum des Saarlandes, 66421 Homburg, Saar, Germany.
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35
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Saburkina I, Gukauskiene L, Rysevaite K, Brack KE, Pauza AG, Pauziene N, Pauza DH. Morphological pattern of intrinsic nerve plexus distributed on the rabbit heart and interatrial septum. J Anat 2014; 224:583-93. [PMID: 24527844 DOI: 10.1111/joa.12166] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/15/2014] [Indexed: 12/14/2022] Open
Abstract
Although the rabbit is routinely used as the animal model of choice to investigate cardiac electrophysiology, the neuroanatomy of the rabbit heart is not well documented. The aim of this study was to examine the topography of the intrinsic nerve plexus located on the rabbit heart surface and interatrial septum stained histochemically for acetylcholinesterase using pressure-distended whole hearts and whole-mount preparations from 33 Californian rabbits. Mediastinal cardiac nerves entered the venous part of the heart along the root of the right cranial vein (superior caval vein) and at the bifurcation of the pulmonary trunk. The accessing nerves of the venous part of the heart passed into the nerve plexus of heart hilum at the heart base. Nerves approaching the heart extended epicardially and innervated the atria, interatrial septum and ventricles by five nerve subplexuses, i.e. left and middle dorsal, dorsal right atrial, ventral right and left atrial subplexuses. Numerous nerves accessed the arterial part of the arterial part of the heart hilum between the aorta and pulmonary trunk, and distributed onto ventricles by the left and right coronary subplexuses. Clusters of intrinsic cardiac neurons were concentrated at the heart base at the roots of pulmonary veins with some positioned on the infundibulum. The mean number of intrinsic neurons in the rabbit heart is not significantly affected by aging: 2200 ± 262 (range 1517-2788; aged) vs. 2118 ± 108 (range 1513-2822; juvenile). In conclusion, despite anatomic differences in the distribution of intrinsic cardiac neurons and the presence of well-developed nerve plexus within the heart hilum, the topography of all seven subplexuses of the intrinsic nerve plexus in rabbit heart corresponds rather well to other mammalian species, including humans.
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Affiliation(s)
- Inga Saburkina
- Institute of Anatomy, Faculty of Medicine, Lithuanian University of Health Sciences, Kaunas, Lithuania
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Zarzoso M, Rysevaite K, Milstein ML, Calvo CJ, Kean AC, Atienza F, Pauza DH, Jalife J, Noujaim SF. Nerves projecting from the intrinsic cardiac ganglia of the pulmonary veins modulate sinoatrial node pacemaker function. Cardiovasc Res 2013; 99:566-75. [PMID: 23559611 DOI: 10.1093/cvr/cvt081] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
AIMS Pulmonary vein ganglia (PVG) are targets for atrial fibrillation ablation. However, the functional relevance of PVG to the normal heart rhythm remains unclear. Our aim was to investigate whether PVG can modulate sinoatrial node (SAN) function. METHODS AND RESULTS Forty-nine C57BL and seven Connexin40+/EGFP mice were studied. We used tyrosine-hydroxylase (TH) and choline-acetyltransferase immunofluorescence labelling to characterize adrenergic and cholinergic neural elements. PVG projected postganglionic nerves to the SAN, which entered the SAN as an extensive, mesh-like neural network. PVG neurones were adrenergic, cholinergic, and biphenotypic. Histochemical characterization of two human embryonic hearts showed similarities between mouse and human neuroanatomy: direct neural communications between PVG and SAN. In Langendorff perfused mouse hearts, PVG were stimulated using 200-2000 ms trains of pulses (300 μs, 400 µA, 200 Hz). PVG stimulation caused an initial heart rate (HR) slowing (36 ± 9%) followed by acceleration. PVG stimulation in the presence of propranolol caused HR slowing (43 ± 13%) that was sustained over 20 beats. PVG stimulation with atropine progressively increased HR. Time-course effects were enhanced with 1000 and 2000 ms trains (P < 0.05 vs. 200 ms). In optical mapping, PVG stimulation shifted the origin of SAN discharges. In five paroxysmal AF patients undergoing pulmonary vein ablation, application of radiofrequency energy to the PVG area during sinus rhythm produced a decrease in HR similar to that observed in isolated mouse hearts. CONCLUSION PVG have functional and anatomical biphenotypic characteristics. They can have significant effects on the electrophysiological control of the SAN.
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Affiliation(s)
- Manuel Zarzoso
- Center for Arrhythmia Research, University of Michigan, Ann Arbor, MI, USA
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Kawashima T, Thorington RW, Sato F. Systematic and comparative morphologies of the extrinsic cardiac nervous system in lemurs (Primates: Strepsirrhini: Infraorder Lemuriformes, Gray, 1821) with evolutionary morphological implications. ZOOL ANZ 2013. [DOI: 10.1016/j.jcz.2012.04.001] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
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Functional and topographic concordance of right atrial neural structures inducing sinus tachycardia. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2013; 788:273-82. [PMID: 23835988 DOI: 10.1007/978-94-007-6627-3_38] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Cardiorespiratory autonomic control is in tight interaction with an intracardiac neural network modulating sinus node function. To gain novel mechanistical insights and to investigate possible novel targets concerning the treatment of inadequate sinus tachycardia, we aimed to characterize functionally and topographically the right atrial neural network modulating sinus node function. In 16 sheep 3-dimensional electro-anatomical mapping of the right atrium was performed. In five animals additionally magnetically steered remote navigation was used. Selective stimulation of nerve fibers was conducted by applying high frequency (200 Hz) electrical impulses within the atrial refractory period. Histological analysis of whole heart preparations by acetylcholinesterase staining was performed and compared to the acquired neuroanatomical mapping.We found that neural stimulation in the cranial part of the right atrium, within a perimeter around the sinus node area, elicited predominantly shortening of the sinus cycle length of -20.3 ± 10.1 % (n = 80, P < 0.05). Along the course of the crista terminalis atrial premature beats (n = 117) and atrial fibrillation (n = 123) could be induced. Catheter stability was excellent during remote catheter navigation. Histological work-up (n = 4) was in accord with the distribution of neurostimulation sites. Ganglions were mainly innervated by the dorsal right-atrial subplexus, with substantial additional input from the ventral right atrial subplexus. In conclusion, our findings suggest a functional and topographic concordance of right atrial neural structures inducing sinus tachycardia. This might open up new avenues in the treatment of heart rate related disorders.
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Kawashima T, Sato F. Detailed comparative anatomy of the extrinsic cardiac nerve plexus and postnatal reorganization of the cardiac position and innervation in the great apes: orangutans, gorillas, and chimpanzees. Anat Rec (Hoboken) 2011; 295:438-53. [PMID: 22190256 DOI: 10.1002/ar.21530] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2011] [Accepted: 08/17/2011] [Indexed: 12/16/2022]
Abstract
To speculate how the extrinsic cardiac nerve plexus (ECNP) evolves phyletically and ontogenetically within the primate lineage, we conducted a comparative anatomical study of the ECNP, including an imaging examination in the great apes using 20 sides from 11 bodies from three species and a range of postnatal stages from newborns to mature adults. Although the position of the middle cervical ganglion (MG) in the great apes tended to be relatively lower than that in humans, the morphology of the ECNP in adult great apes was almost consistent with that in adult humans but essentially different from that in the lesser apes or gibbons. Therefore, the well-argued anatomical question of when did the MG acquire communicating branches with the spinal cervical nerves and appear constantly in all sympathetic cardiac nerves during primate evolution is clearly considered to be after the great apes and gibbons split. Moreover, a horizontal four-chambered heart and a lifted cardiac apex with a relatively large volume in newborn great apes rapidly changed its position downward, as seen in humans during postnatal growth and was associated with a reduction in the hepatic volume by imaging diagnosis and gross anatomy. In addition, our observation using a range of postnatal stages exhibits that two sympathetic ganglia, the middle cervical and cervicothoracic ganglia, differed between the early and later postnatal stages.
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Affiliation(s)
- Tomokazu Kawashima
- Department of Anatomy, School of Medicine, Toho University, Tokyo, Japan.
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Castaño A, Crawford T, Yamazaki M, Avula UMR, Kalifa J. Coronary artery pathophysiology after radiofrequency catheter ablation: review and perspectives. Heart Rhythm 2011; 8:1975-80. [PMID: 21740881 DOI: 10.1016/j.hrthm.2011.07.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/16/2010] [Accepted: 07/04/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Radiofrequency ablation (RFA) has proven to be an effective and safe treatment in patients with ventricular and atrial tachyarrhythmias. Among complications arising after RFA, the incidence of coronary artery (CA) injury is exceedingly low. When CA injury does occur, however, it can be clinically devastating. The proximity of CAs to common ablation sites suggests that the relationship between RFA and CA perfusion pathophysiology is important for optimal lesion formation and safe arrhythmia treatments. OBJECTIVE Although others have described the presentation and outcomes of patients with CA injury after ablation, a review that consolidates the mechanisms of CA injury after RFA has yet to be presented in the cardiology literature. METHODS We conducted an extensive literature search of studies published over the past 30 years that relate the biophysics of RFA with CA perfusion pathophysiology and injury. RESULTS We present a review of the dynamic relationship between RFA and CA perfusion. We describe RFA lesion pathology, mechanisms of CA injury from RFA, and factors that influence lesion formation, such as convective cooling and the shadow effect. CONCLUSION We summarize methods to mitigate CA injury after RFA and propose new research avenues to optimize lesion formation and safe arrhythmia treatments when tissue is ablated in the vicinity of CAs.
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Affiliation(s)
- Adam Castaño
- Department of Internal Medicine, Columbia University Medical Center, New York, New York, USA
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Cui B, Lu Z, He B, Hu X, Wu B, Xu S, Huang C, Jiang H. Acute effects of ganglionated plexi ablation on sinoatrial nodal and atrioventricular nodal functions. Auton Neurosci 2011; 161:87-94. [DOI: 10.1016/j.autneu.2011.01.004] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2010] [Revised: 12/19/2010] [Accepted: 01/13/2011] [Indexed: 11/16/2022]
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Remembrances of time past, or À la recherche du temps perdu. Heart Rhythm 2010; 7:951-2. [DOI: 10.1016/j.hrthm.2010.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2010] [Indexed: 11/21/2022]
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Saburkina I, Rysevaite K, Pauziene N, Mischke K, Schauerte P, Jalife J, Pauza DH. Epicardial neural ganglionated plexus of ovine heart: anatomic basis for experimental cardiac electrophysiology and nerve protective cardiac surgery. Heart Rhythm 2010; 7:942-50. [PMID: 20197118 DOI: 10.1016/j.hrthm.2010.02.036] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2010] [Accepted: 02/24/2010] [Indexed: 11/30/2022]
Abstract
BACKGROUND Sheep are routinely used in experimental cardiac electrophysiology and surgery. OBJECTIVE The purpose of this study was to (1) ascertain the topography and architecture of the ovine epicardial neural plexus (ENP), (2) determine the relationships of ENP with vagal and sympathetic cardiac nerves and ganglia, and (3) evaluate gross anatomic differences and similarities of ENP in humans, sheep, and other species. METHODS Ovine ENP and extrinsic sympathetic and vagal nerves were stained histochemically for acetylcholinesterase in whole heart and/or thorax-dissected preparations from 23 newborn lambs, with subsequent examination by stereomicroscope. RESULTS Intrinsic cardiac nerves extend from the venous part of the ovine heart hilum along the roots of the cranial (superior) caval and left azygos veins to both atria and ventricles via five epicardial routes: dorsal right atrial, middle dorsal, left dorsal, right ventral, and ventral left atrial nerve subplexuses. Intrinsic nerves proceeding from the arterial part of the heart hilum along the roots of the aorta and pulmonary trunk extend exclusively into the ventricles as the right and left coronary subplexuses. The dorsal right atrial, right ventral, and middle dorsal subplexuses receive the main extrinsic neural input from the right cervicothoracic and right thoracic sympathetic T(2) and T(3) ganglia as well as from the right vagal nerve. The left dorsal is supplied by sizeable extrinsic nerves from the left thoracic T(4)-T(6) sympathetic ganglia and the left vagal nerve. Sheep hearts contained an average of 769 +/- 52 epicardial ganglia. Cumulative areas of epicardial ganglia on the root of the cranial vena cava and on the wall of the coronary sinus were the largest of all regions (P <.05). CONCLUSION Despite substantial interindividual variability in the morphology of ovine ENP, right-sided epicardial neural subplexuses supplying the sinoatrial and atrioventricular nodes are mostly concentrated at a fat pad between the right pulmonary veins and the cranial vena cava. This finding is in sharp contrast with a solely left lateral neural input to the human atrioventricular node, which extends mainly from the left dorsal and middle dorsal subplexuses. The abundance of epicardial ganglia distributed widely along the ovine ventricular nerves over respectable distances below the coronary groove implies a distinctive neural control of the ventricles in human and sheep hearts.
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Affiliation(s)
- Inga Saburkina
- Institute of Anatomy, Kaunas University of Medicine, Kaunas, Lithuania
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Florencio Gama E, Maria Santarém J, Aparecido Liberti E, Jacob Filho W, de Souza RR. Exercise changes the size of cardiac neurons and protects them from age-related neurodegeneration. Ann Anat 2010; 192:52-7. [DOI: 10.1016/j.aanat.2009.09.004] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2009] [Revised: 08/12/2009] [Accepted: 09/08/2009] [Indexed: 11/29/2022]
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Sakamoto SI, Schuessler RB, Lee AM, Aziz A, Lall SC, Damiano RJ. Vagal denervation and reinnervation after ablation of ganglionated plexi. J Thorac Cardiovasc Surg 2009; 139:444-52. [PMID: 19740492 DOI: 10.1016/j.jtcvs.2009.04.056] [Citation(s) in RCA: 81] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2009] [Revised: 04/01/2009] [Accepted: 04/23/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Surgical ablation of ganglionated plexi has been proposed to increase efficacy of surgery for atrial fibrillation. This experimental canine study examined electrophysiologic attenuation and recovery of atrial vagal effects after ganglionated plexi ablation alone or with standard surgical lesion sets for atrial fibrillation. METHODS Dogs were divided into 3 groups: group 1 (n = 6) had focal ablation of the 4 major epicardial ganglionated plexi fat pads, group 2 (n = 6) had pulmonary vein isolation with ablation, and group 3 (n = 6) had posterior left atrial isolation with ablation. All fat pads were ablated. Sinus and atrioventricular interval changes during bilateral vagosympathetic trunk stimulation were examined before and both immediately and 4 weeks after ablation. Vagally induced effective refractory period changes and mean QRST area changes (index of local innervation) were examined in 5 atrial regions. RESULTS Sinus and atrioventricular interval changes and heart rate variability decreased immediately after ablation, but only sinus interval changes were restored significantly after 4 weeks in all groups. Ablation-modified vagal effects on effective refractory period or QRST area changed heterogeneously in groups 1 and 2. In group 3, regional vagal effects were attenuated extensively postablation in both atria. Posterior left atrial isolation with ablation incrementally denervated the atria. In the long term, vagal stimulation increased QRST area changes relative to control values in all groups. Heart rate variability was also assessed. CONCLUSIONS Ganglionated plexi ablation significantly reduced atrial vagal innervation. Restoration of vagal effects at 4 weeks suggests early atrial reinnervation.
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Affiliation(s)
- Shun-ichiro Sakamoto
- Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine, Barnes-Jewish Hospital, St Louis, MO 63110, USA
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Saburkina I, Pauziene N, Pauza DH. Prenatal Development of the Human Epicardiac Ganglia. Anat Histol Embryol 2009; 38:194-9. [DOI: 10.1111/j.1439-0264.2008.00919.x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Hasan W, Smith PG. Modulation of rat parasympathetic cardiac ganglion phenotype and NGF synthesis by adrenergic nerves. Auton Neurosci 2008; 145:17-26. [PMID: 19019738 DOI: 10.1016/j.autneu.2008.10.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2008] [Revised: 09/22/2008] [Accepted: 10/09/2008] [Indexed: 01/14/2023]
Abstract
Cardiac function is regulated by interactions among intrinsic and extrinsic autonomic neurons, and the mechanisms responsible for organizing these circuits are poorly understood. Parasympathetic neurons elsewhere synthesize the neurotrophin NGF, which may promote postganglionic axonal associations where parasympathetic axons inhibit sympathetic transmitter release. Previous studies have shown that parasympathetic NGF content and neurochemical phenotype are regulated by sympathetic innervation. In this study we assessed contributions of sympathetic input on cardiac ganglion neuronal phenotype and NGF expression. Because cardiac ganglia are reported to contain putative noradrenergic neurons, we eliminated sympathetic input both surgically (extrinsic) and chemically (extrinsic plus intrinsic). In controls, most cardiac ganglion neurons expressed vesicular acetylcholine transporter, frequently colocalized with vesicular monoamine transporter, but lacked catecholamine histofluorescence. Most cardiac ganglion neurons expressed NGF transcripts, and 40% contained mature and 47% proNGF immunoreactivity. Guanethidine treatment for 7 days decreased numbers of neurons expressing vesicular acetylcholine transporter, NGF transcripts and NGF immunoreactivity, but did not affect proNGF or vesicular monoamine transporter immunoreactivity. Stellate ganglionectomy had comparable effects on neurochemical phenotype and mature NGF immunoreactivity, but proNGF expression was additionally reduced. These findings show that individual cardiac ganglion neurons display markers of both cholinergic and noradrenergic transmission. Sympathetic noradrenergic innervation maintains levels of cholinergic but not noradrenergic marker protein. Sympathetic innervation also promotes cardiac ganglion neuronal NGF synthesis. Because chemical blockade of all noradrenergic transmission is no more effective than extrinsic sympathectomy, local intrinsic noradrenergic transmission is not a factor in regulating ganglion neuron phenotype.
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Affiliation(s)
- Wohaib Hasan
- Department of Molecular and Integrative Physiology, University of Kansas Medical Center, Kansas City, Kansas 66160, USA.
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Vaitkevicius R, Saburkina I, Rysevaite K, Vaitkeviciene I, Pauziene N, Zaliunas R, Schauerte P, Jalife J, Pauza DH. Nerve supply of the human pulmonary veins: an anatomical study. Heart Rhythm 2008; 6:221-8. [PMID: 19187915 DOI: 10.1016/j.hrthm.2008.10.027] [Citation(s) in RCA: 66] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Accepted: 10/20/2008] [Indexed: 10/21/2022]
Abstract
BACKGROUND Atrial ectopic discharges originating in the pulmonary veins (PVs) are known to initiate atrial fibrillation (AF), which may be terminated by catheter-based PV isolation. Because a functional relationship exists between cardiac autonomic effects and PVs in arrhythmogenesis, it has been suggested that discharges of the nerves that proceed to the PVs and interconnect with intrinsic ganglionated nerve plexuses are potential triggers of AF in man. OBJECTIVE This study sought to determine the characteristics and distribution of neural routes by which autonomic nerves supply the human PVs. METHODS We examined the intrinsic neural structures of 35 intact (nonsectioned) left atrial (LA)-PV complexes stained transmurally for acetylcholinesterase using a stereomicroscope. RESULTS The epicardial ganglionated nerves pass onto the extrapulmonary segments of the human PVs from the middle, left dorsal, and dorsal right atrial subplexuses. The left and right inferior PVs involved a lesser number of ganglia than the left and right superior PVs. Abundant extensions of epicardial nerves penetrate transmurally the PV walls and form a patchy neural network beneath the endothelium of PVs. The subendothelial neural meshwork with numerous free nerve endings, which appeared to be typical sensory compact nerve endings, was mostly situated at the roots of the 4 PVs. No ganglia were identified beneath the endothelium of the human PVs. CONCLUSION The richest areas containing epicardial ganglia, from which intrinsic nerves extend to the human PVs, are concentrated at the inferior surface of both the inferior and left superior PVs. Therefore, these locations might be considered as potential targets for focal pulmonary vein ablation in catheter-based therapy of AF.
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Innervation of pulmonary veins: Morphologic pattern and pathways of nerves in the human fetus. Ann Anat 2008; 190:158-66. [DOI: 10.1016/j.aanat.2007.09.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2007] [Revised: 09/04/2007] [Accepted: 09/11/2007] [Indexed: 11/18/2022]
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