Autonomic mechanism for initiation of rapid firing from atria and pulmonary veins: evidence by ablation of ganglionated plexi
Autonomic mechanism for initiation of rapid firing from atria and pulmonary veins: evidence by ablation of ganglionated plexi
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DOI：
10.1093/cvr/cvp194
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发表时间：
2009-11-01
影响因子：
10.8
通讯作者：
Po, Sunny S.
中科院分区：
文献类型：
--
作者：
Lu, Zhibing;Scherlag, Benjamin J.;Po, Sunny S.
先前的研究表明，在体外和体内，心肌难治性时，高频电刺激（HFS）的自主神经激活可引起肺静脉（PV）和心房的快速放电。本研究旨在通过系统消融多神经节丛（GP）来探讨不同部位快速放电的自主机制。方法和结果对43只杂种犬进行快速点火介导的心房颤动试验。在心肌难治性时，用200 Hz、脉冲持续0.1 ms、训练持续40 ms的局部高频脉冲刺激（HFS）诱导pv和心房颤动（AF）。然后消融心房脂肪垫或沿马歇尔韧带（LCM）的神经节中的主要GP。消融右前GP和右下GP显著提高了HFS对右心房和pv的AF阈值。左上GP和左下GP消融后，左心房和pv的AF阈值显著升高，而LOM消融后，AF阈值进一步升高。左侧或右侧心房GP消融对侧pv和心房有显著影响。施用艾司洛尔（1mg /kg）或阿托品（1mg）可显著提高所有部位的房颤阈值。结论HFS应用于局部心房和PV部位，通过激活心脏相互作用的自主神经网络，引发快速放电。左侧或右侧GP均可导致源自同侧、对侧pv和心房的快速放电和房颤。自主神经去支配抑制或消除这些快速放电。
Aims Previous studies showed that autonomic activation by high-frequency electrical stimulation (HFS) during myocardial refractoriness evokes rapid firing from pulmonary vein (PV) and atria, both in vitro and in vivo. This study sought to investigate the autonomic mechanism underlying the rapid firings at various sites by systematic ablation of multiple ganglionated plexi (GP).Methods and results In 43 mongrel dogs, rapid firing-mediated atrial. fibrillation (AF) was induced by local HFS (200 Hz, impulse duration 0.1 ms, train duration 40 ms) to the PVs and atria during myocardial refractoriness. The main GP in the atrial fat pads or the ganglia along the ligament of Marshall (LCM) were then ablated. Ablation of the anterior right GP and inferior right GP significantly increased the AF threshold by HFS at the right atrium and PVs. The AF threshold at left atrium and PVs was significantly increased by ablation of the superior left GP and inferior left GP, and was further increased by ablation of the LOM. Ablation of left- or right-sided GP on the atria had a significant effect on contralateral PVs and atrium. Administration of esmolol (1 mg/kg) or atropine (1 mg) significantly increased AF threshold at all sites.Conclusion HFS applied to local atrial and PV sites initiated rapid firing via activation of the interactive autonomic network in the heart. GP in either left side or right side contributes to the rapid firings and AF originating from ipsolateral and contralateral PVs and atrium. Autonomic denervation suppresses or eliminates those rapid firings.