Interactive atrial neural network: Determining the connections between ganglionated plexi.
BACKGROUND
The electrophysiologic functions of the intrinsic cardiac autonomic nervous system (ANS) are not well understood.


OBJECTIVE
The purpose of this study was to investigate the functional interactions between ganglionated plexi within the intrinsic cardiac ANS.


METHODS
The hearts of 21 dogs were exposed via right and/or left thoracotomy to expose the (1) anterior right ganglionated plexi near the caudal end of the sinoatrial node, (2) inferior right ganglionated plexi at the junction of inferior vena cava and atria, and (3) superior left ganglionated plexi near the junction of left superior pulmonary vein and left pulmonary artery. Ganglionated plexi were stimulated at 0.6 to 8.0 V (square waves, 20 Hz, 0.1-ms duration). Sinus rate, AH interval during atrial pacing, and ventricular rate during atrial fibrillation were compared before and after ganglionated plexi stimulation and after their ablation.


RESULTS
Anterior right ganglionated plexi stimulation induced significant AH prolongation and slowing of ventricular rate and sinus rate. When inferior right ganglionated plexi was ablated, slowing of sinus rate by anterior right ganglionated plexi stimulation was unaltered, but inhibition of AV conduction was eliminated. Superior left ganglionated plexi stimulation induced similar effects on sinus and AV nodal function, and sinus rate slowing was markedly attenuated by anterior right ganglionated plexi ablation. Ablation of both anterior right ganglionated plexi and inferior right ganglionated plexi eliminated AV conduction inhibition but not sinus rate slowing by superior left ganglionated plexi stimulation.


CONCLUSIONS
This study provides functional evidence for the interconnections between ganglionated plexi to modulate sinus and AV nodal function, supporting clinical evidence that interconnections within the intrinsic cardiac ANS are critical elements in identifying the targets for atrial fibrillation ablation.
Hou
Yinglong
Y
Department of Cardiology, Shandong Provincial Qianfoshan Hospital, Clinical Medical College of Shandong University, Jinan City, Shandong, China.
Scherlag
Benjamin J
BJ
Lin
Jiaxiong
J
Zhou
Jing
J
Song
Jianguo
J
Zhang
Ying
Y
Patterson
Eugene
E
Lazzara
Ralph
R
Jackman
Warren M
WM
Po
Sunny S
SS
D000818:Animals; D001281:Atrial Fibrillation / Q000503:physiopathology*; D001341:Autonomic Nervous System / Q000503:physiopathology*; D018780:Body Surface Potential Mapping; D017115:Catheter Ablation; D004285:Dogs; D005724:Ganglia / Q000502:physiology*; D006325:Heart Atria / Q000503:physiopathology*; D016571:Neural Networks, Computer; D011651:Pulmonary Artery / Q000503:physiopathology; D011667:Pulmonary Veins / Q000503:physiopathology