title: Nerve supply of the human pulmonary veins: an anatomical study.
abstract: BACKGROUND
  Atrial ectopic discharges originating in the pulmonary veins (PVs) are known to initiate atrial fibrillation (AF), which may be terminated by catheter-based PV isolation. Because a functional relationship exists between cardiac autonomic effects and PVs in arrhythmogenesis, it has been suggested that discharges of the nerves that proceed to the PVs and interconnect with intrinsic ganglionated nerve plexuses are potential triggers of AF in man.
  
  
  OBJECTIVE
  This study sought to determine the characteristics and distribution of neural routes by which autonomic nerves supply the human PVs.
  
  
  METHODS
  We examined the intrinsic neural structures of 35 intact (nonsectioned) left atrial (LA)-PV complexes stained transmurally for acetylcholinesterase using a stereomicroscope.
  
  
  RESULTS
  The epicardial ganglionated nerves pass onto the extrapulmonary segments of the human PVs from the middle, left dorsal, and dorsal right atrial subplexuses. The left and right inferior PVs involved a lesser number of ganglia than the left and right superior PVs. Abundant extensions of epicardial nerves penetrate transmurally the PV walls and form a patchy neural network beneath the endothelium of PVs. The subendothelial neural meshwork with numerous free nerve endings, which appeared to be typical sensory compact nerve endings, was mostly situated at the roots of the 4 PVs. No ganglia were identified beneath the endothelium of the human PVs.
  
  
  CONCLUSIONS
  The richest areas containing epicardial ganglia, from which intrinsic nerves extend to the human PVs, are concentrated at the inferior surface of both the inferior and left superior PVs. Therefore, these locations might be considered as potential targets for focal pulmonary vein ablation in catheter-based therapy of AF.
authors.affiliation: Institute for Anatomy, Kaunas University of Medicine, Kaunas, Lithuania.
authors.forename: Raimundas
authors.initials: R
authors.lastname: Vaitkevicius
authors.forename: Inga
authors.initials: I
authors.lastname: Saburkina
authors.forename: Kristina
authors.initials: K
authors.lastname: Rysevaite
authors.forename: Inga
authors.initials: I
authors.lastname: Vaitkeviciene
authors.forename: Neringa
authors.initials: N
authors.lastname: Pauziene
authors.forename: Remigijus
authors.initials: R
authors.lastname: Zaliunas
authors.forename: Patrick
authors.initials: P
authors.lastname: Schauerte
authors.forename: José
authors.initials: J
authors.lastname: Jalife
authors.forename: Dainius H
authors.initials: DH
authors.lastname: Pauza
mesh_terms: D000293:Adolescent; D000328:Adult; D001281:Atrial Fibrillation / Q000503:physiopathology; D001341:Autonomic Nervous System / Q000033:anatomy & histology*; D005260:Female; D006801:Humans; D008297:Male; D011667:Pulmonary Veins / Q000294:innervation* / Q000503:physiopathology