Local innervation and atrial fibrillation.
Local innervation and atrial fibrillation.
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DOI：
10.1161/circulationaha.113.001596
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发表时间：
2013-10-01
期刊：
影响因子：
37.8
通讯作者：
Patel VV
中科院分区：
文献类型：
--
作者：
Wickramasinghe SR;Patel VV
与ECNS相对简单的解剖结构形成鲜明对比的是，ICNS更复杂，其精确的解剖结构仍不完全清楚（图1）。在进入心包腔时，大多数交感传入神经直接支配心肌或与构成心内神经节的神经元形成突触。相反，副交感神经纤维几乎完全与位于整个心脏许多位置的心脏神经节内的神经元突触。值得注意的是，每个心脏神经节可以包含200至1000个神经元，12，13，并且这些神经节中的绝大多数被组织成心房和心室表面上的GP。[13]这些心房丛中的一些已被标测到上级右心房（邻近窦房结）、上级左心房和后右心房（邻近房室结），但也存在大量形式上未标测的较小心房丛。[14]肺静脉-左心房（PV-LA）交界处尤其具有GP的汇合，并接受自主神经系统的两个分支的神经支配。大量数据表明，直接刺激肺静脉-左心房交界处的GP可诱发房颤。15，16相反，在一些研究中，肺静脉-左心房交界处和肺静脉口的主要GP被消融，已经实现了既存AF的衰减或消失。17-20一些研究者基于这种性质的实验证据，我认为心房GP作为整合单位，与ECNS的组成部分协同作用，以管理心脏和自主神经之间的串扰系统心房GP还保留了独立行动和调节许多心脏功能的能力，如起搏器自动性、心肌收缩性和不应性。越来越多的证据表明，GP在AF的发生和传播中起着重要作用。
In stark contrast to the relatively straightforward anatomy of the ECNS, the ICNS is more complex, and its precise anatomy is still not completely known (Figure 1). On entering the pericardial space, the majority of sympathetic afferents either directly innervate the myocardium or form synapses with neurons that constitute the intrinsic cardiac ganglia. Parasympathetic fibers, in contrast, almost entirely synapse with neurons within the cardiac ganglia located in a number of locations throughout the heart. Of note, each cardiac ganglion may contain anywhere from 200 to 1000 neurons, 12, 13 and the vast majority of these ganglia are organized into GPs on the surface of the atria and ventricles. 13 Some of these atrial plexi have been mapped to the superior right atrium (adjacent to the sinoatrial node), superior left atrium and posterior right atrium (adjacent to the atrioventricular node), but a large number of formally unmapped smaller atrial plexi also exist. 14 The pulmonary vein-left atrial (PV-LA) junction in particular has a confluence of GPs and receives innervation from both limbs of the autonomic nervous system. A fair amount of data suggest that AF can be induced by directly stimulating the GPs at the PV-LA junction. 15, 16 Conversely, several studies in which the major GPs in the PV-LA junction and the PV ostia were ablated have achieved attenuation or extinction of preexisting AF. 17–20 Some investigators, based on experimental evidence of this nature, have suggested that the atrial GPs serve as integration units that act cooperatively with components of the ECNS to manage cross talk between the heart and the autonomic nervous system. Atrial GPs also retain the ability to act independently and modulate numerous cardiac functions, such as pacemaker automaticity, myocardial contractility, and refractoriness. This body of growing evidence is helping to establish that GPs play an important role in the genesis and propagation of AF.