Ganglionated plexi modulate extrinsic cardiac autonomic nerve input - Effects on sinus rate, atrioventricular conduction, refractoriness, and inducibility of atrial fibrillation
Ganglionated plexi modulate extrinsic cardiac autonomic nerve input - Effects on sinus rate, atrioventricular conduction, refractoriness, and inducibility of atrial fibrillation
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DOI：
10.1016/j.jacc.2007.02.066
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发表时间：
2007-07-03
影响因子：
24
通讯作者：
Po, Sunny S.
中科院分区：
文献类型：
--
作者：
Hou, Yinglong;Scherlag, Benjamin J.;Po, Sunny S.
目的系统研究心脏自主神经系统(ANS)对房颤(房颤)电生理特性和房颤发生的调控作用。本研究未详细介绍系统消融心脏内外神经节丛(GP)以评价外源性和内源性心脏自主神经系统(ANS)关系的研究。方法28只犬暴露于右前神经节(ARGP)、下腔静脉与心房交界处的右下神经节丛(IRGP)和左上肺静脉与左肺动脉交界处的左上神经节丛(SLGP)。采用单侧迷走神经干刺激(0.6~8.0V，持续时间20 Hz，0.1ms)，比较消融SLGP、ARGP和IRGP前后房颤时窦性心率(SR)和心室率(VR)的变化。结果SLGP消融显著减弱左右迷走神经干刺激的SR和VR减慢反应。随后的ARGP消融对SR减慢产生额外的影响，但对VR减慢没有影响。在SLGP+ARGP消融后，IRGP消融消除了VR减慢，但不能进一步减弱刺激迷走神经干引起的SR减慢。单侧右、左侧迷走神经干刺激可缩短ARGP和SLGP附近心房和肺静脉的有效不应期，增加房颤的诱发率。ARGP消融消除了刺激右侧迷走神经干诱发的ERP缩短和房颤，而SLGP消融消除了刺激左侧迷走神经干诱发的ERP缩短，但不能诱发房颤。结论GP是调节心内外自主神经相互作用的“整合中枢”。这种互动比之前认为的要复杂得多。
Objectives This study sought to systematically investigate the interactions between the extrinsic and intrinsic cardiac autonomic nervous system (ANS) in modulating electrophysiological properties and atrial fibrillation (AF) initiation.Background Systematic ganglionated plexi (GP) ablation to evaluate the extrinsic and intrinsic cardiac ANS relationship has not been detailed.Methods The following GP were exposed in 28 dogs: anterior right GP (ARGP) near the sinoatrial node, inferior right ganglionated plexi (IRGP) at the junction of the inferior vena cava and atria, and superior left ganglionated plexi (SLGP) near the junction of left superior pulmonary vein and left pulmonary artery. With unilateral vagosympathetic trunk stimulation (0.6 to 8.0 V, 20 Hz, 0.1 ms in duration), sinus rate (SR), and ventricular rate (VR) during AF were compared before and after sequential ablation of SLGP, ARGP, and IRGP.Results The SLGP ablation significantly attenuated the SR and VR slowing responses with right or left vagosympathetic trunk stimulation. Subsequent ARGP ablation produced additional effects on SR slowing but not VR slowing. After SLGP + ARGP ablation, IRGP ablation eliminated VR slowing but did not further attenuate SR slowing with vagosympathetic trunk stimulation. Unilateral right and left vagosympathetic trunk stimulation shortened the effective refractory period and increased AF inducibility of atrium and pulmonary vein near the ARGP and SLGP, respectively. The ARGP ablation eliminated ERP shortening and AF inducibility with right vagosympathetic trunk stimulation, whereas SLGP ablation eliminated ERP shortening but not AF inducibility with left vagosympathetic trunk stimulation.Conclusions The GP function as the "integration centers" that modulate the autonomic interactions between the extrinsic and intrinsic cardiac ANS. This interaction is substantially more intricate than previously thought.