title: The increase in sympathetic nerve density in the atrium facilitates atrial fibrillation in patients with rheumatic heart disease.
abstract: BACKGROUND
  Atrial fibrillation (Af) is frequently observed in patients with rheumatic heart disease (RHD). The hyperactivity of autonomic nervous system is known to contribute to the occurrence of Af in RHD patients. This study investigated the association between the autonomic density and the risk of Af in RHD patients.
  
  
  METHODS
  Seventy-five patients were enrolled: (1) RHD patients with Af (N = 25, Group 1); (2) RHD patients without Af (N = 25, Group 2); (3) congenital heart disease patients without Af (N = 25, Group 3). The baseline characteristics and the blood concentrations of renin, C-reaction protein and angiotensin II were collected from all patients. The tissues were obtained from the right atrial appendage during the open-heart surgery and then stained using immunohistochemical methods with autonomic antibodies.
  
  
  RESULTS
  The sympathetic nerve density was significantly higher in RHD patients with Af than RHD patients without Af and congenital heart disease patients, both endocardially and epicardially. The parasympathetic nerve density did not show significant difference among the three groups. The left atrial diameter was larger in RHD patients with Af than the other two groups. The blood concentrations of renin and angiotensin II were higher in RHD patients with Af than the other two groups. The erythrocyte sedimentation rate and blood concentrations of C-reaction protein did not show significant change among the three groups.
  
  
  CONCLUSIONS
  This study provided direct evidence of the increase in sympathetic nerve density in atrium in patients with RHD. This phenomenon may be associated with the development of Af in RHD patients.
authors.affiliation: Department of Cardiology, Renmin Hospital of Wuhan University, Wuhan, People's Republic of China.
authors.forename: Yuanhong
authors.initials: Y
authors.lastname: Li
authors.forename: Zhibing
authors.initials: Z
authors.lastname: Lu
authors.forename: Qizhu
authors.initials: Q
authors.lastname: Tang
authors.forename: Hong
authors.initials: H
authors.lastname: Jiang
authors.forename: Congxin
authors.initials: C
authors.lastname: Huang
authors.forename: Bo
authors.initials: B
authors.lastname: He
authors.forename: Xiaorong
authors.initials: X
authors.lastname: Hu
authors.forename: Jinqi
authors.initials: J
authors.lastname: Huang
authors.forename: Xiaoqing
authors.initials: X
authors.lastname: Zhu
authors.forename: Hongli
authors.initials: H
authors.lastname: Wang
mesh_terms: D000293:Adolescent; D000328:Adult; D020517:Atrial Appendage / Q000294:innervation / Q000473:pathology; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology*; D001338:Autonomic Fibers, Postganglionic / Q000473:pathology*; D005260:Female; D006325:Heart Atria / Q000294:innervation* / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D012214:Rheumatic Heart Disease / Q000453:epidemiology / Q000473:pathology*; D055815:Young Adult