How the pulmonary veins 'talk' to the sinoatrial node: new insights into an old mystery.
How the pulmonary veins 'talk' to the sinoatrial node: new insights into an old mystery.
复制标题
肺静脉如何与窦房结“对话”：对一个古老谜团的新见解。
DOI：
10.1093/cvr/cvt175
复制
发表时间：
2013
影响因子：
10.8
通讯作者：
Arora,Rishi
中科院分区：
文献类型：
--
作者：
Arora,Rishi
The role of the autonomic nervous system (ANS) in the genesis of atrial arrhythmias has been extensively studied in the past, 1, 2 with both the parasympathetic and the sympathetic nervous system having been implicated in the genesis of atrial fibrillation (AF). 3, 4 The discovery over a decade ago of the role of the pulmonary veins (PVs) in the genesis of AF has generated renewed interest in understanding the autonomic profile of the atria, in order to understand the role of the ANS in the genesis of focal triggers in the PVs. Clinical and animal data suggest that these PV trigger and drivers appear to be at least partially modulated by the ANS, 4–6 with different studies implicating either the sympathetic or the parasympathetic nervous system in the genesis and/or maintenance of focal AF. More recent studies postulate a dominant role for the parasympathetic nervous system (in focal AF), in part on account of the vagal or Bezold–Jarisch-like reflexes (eg sinus bradycardia, asystole, AV block, or hypotension) noted during radiofrequency ablation of the PV tissues in patients with paroxysmal focal AF. 7 Indeed, some clinical studies have suggested that the attenuation of these ‘vagal’reflexes at the time of AF ablation may increase success of ablation procedures for AF. 7 However, other studies that attempt to target the PV ganglia (PVGs) by using this vagal reflex have not systematically shown an improvement in ablation success. 8 This variability in ablation success is thought to be at least partially due to our poor understanding of the mechanisms underlying this bradycardia reflex (and more broadly speaking, of the autonomic profile of the atria and PVs). Indeed, the complete autonomic profile of the PVs and the precise role of the ANS in the genesis of focal AF are just beginning to be systematically investigated in clinical and animal models.The study by Zarzoso et al. 9 is therefore timely, as it sheds important light on how the PVG communicate with the sinus node. In this issue of the journal, Zarzosoet al. demonstrate the presence of inter-connecting nerves between the PVG and the sinus node. They further demonstrate that these inter-connecting nerves contain both parasympathetic and sympathetic nerve fibres. The investigators also delve into the physiological function of these nerves by assessing the effect of PVG stimulation
