title: The man who feels two hearts: the different pathways of interoception.
abstract: Recent advances in neuroscience have provided new insights into the understanding of heart-brain interaction and communication. Cardiac information to the brain relies on two pathways, terminating in the insular cortex (IC) and anterior cingulate cortex (ACC), along with the somatosensory cortex (S1-S2). Interoception relying on these neuroanatomical pathways has been shown to modulate social cognition. We report the case study of C.S., a patient with an 'external heart' (an extracorporeal left-univentricular cardiac assist device, LVAD). The patient was assessed with neural/behavioral measures of cardiac interoception complemented by neuropsychological and social cognition measures. The patient's performance on the interoception task (heartbeat detection) seemed to be guided by signals from the artificial LVAD, which provides a somatosensory beat rather than by his endogenous heart. Cortical activity (HEP, heartbeat-evoked potential) was found decreased in comparison with normal volunteers, particularly during interoceptive states. The patient accurately performed several cognitive tasks, except for interoception-related social cognition domains (empathy, theory of mind and decision making). This evidence suggests an imbalance in the patient's cardiac interoceptive pathways that enhances sensation driven by the artificial pump over that from the cardiac vagal-IC/ACC pathway. A patient with two hearts, one endogenous and one artificial, presents a unique opportunity to explore models of interoception and heart-brain interaction.
authors.affiliation: Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive Neurology (INECO), Favaloro University, Buenos Aires, Institute of Neuroscience, Favaloro University, Buenos Aires, Argentina, National Scientific and Technical Research Council (CONICET), Argentina, Laboratory of Cognitive and Social Neuroscience (LaNCyS), UDP-INECO Foundation Core on Neuroscience (UIFCoN), Diego Portales University, Santiago, Chile, Physics Department, Laboratory of Integrative Neuroscience, University of Buenos Aires, Department of Cardiology and Cardiosurgery, Favaloro University, Buenos Aires, Argentina, Institut National de la Santé et de la Recherche Médicale (INSERM), 91191 Gif sur Yvette, France, The Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK, and Universidad Torcuato Di Tella, Buenos Aires, Argentina Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive Neurology (INECO), Favaloro University, Buenos Aires, Institute of Neuroscience, Favaloro University, Buenos Aires, Argentina, National Scientific and Technical Research Council (CONICET), Argentina, Laboratory of Cognitive and Social Neuroscience (LaNCyS), UDP-INECO Foundation Core on Neuroscience (UIFCoN), Diego Portales University, Santiago, Chile, Physics Department, Laboratory of Integrative Neuroscience, University of Buenos Aires, Department of Cardiology and Cardiosurgery, Favaloro University, Buenos Aires, Argentina, Institut National de la Santé et de la Recherche Médicale (INSERM), 91191 Gif sur Yvette, France, The Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK, and Universidad Torcuato Di Tella, Buenos Aires, Argentina Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive Neurology (INECO), Favaloro University, Buenos Aires, Institute of Neuroscience, Favaloro University, Buenos Aires, Argentina, National Scientific and Technical Research Council (CONICET), Argentina, La
authors.forename: Blas
authors.initials: B
authors.lastname: Couto
authors.affiliation: Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive Neurology (INECO), Favaloro University, Buenos Aires, Institute of Neuroscience, Favaloro University, Buenos Aires, Argentina, National Scientific and Technical Research Council (CONICET), Argentina, Laboratory of Cognitive and Social Neuroscience (LaNCyS), UDP-INECO Foundation Core on Neuroscience (UIFCoN), Diego Portales University, Santiago, Chile, Physics Department, Laboratory of Integrative Neuroscience, University of Buenos Aires, Department of Cardiology and Cardiosurgery, Favaloro University, Buenos Aires, Argentina, Institut National de la Santé et de la Recherche Médicale (INSERM), 91191 Gif sur Yvette, France, The Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK, and Universidad Torcuato Di Tella, Buenos Aires, Argentina Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive Neurology (INECO), Favaloro University, Buenos Aires, Institute of Neuroscience, Favaloro University, Buenos Aires, Argentina, National Scientific and Technical Research Council (CONICET), Argentina, Laboratory of Cognitive and Social Neuroscience (LaNCyS), UDP-INECO Foundation Core on Neuroscience (UIFCoN), Diego Portales University, Santiago, Chile, Physics Department, Laboratory of Integrative Neuroscience, University of Buenos Aires, Department of Cardiology and Cardiosurgery, Favaloro University, Buenos Aires, Argentina, Institut National de la Santé et de la Recherche Médicale (INSERM), 91191 Gif sur Yvette, France, The Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK, and Universidad Torcuato Di Tella, Buenos Aires, Argentina.
authors.forename: Alejo
authors.initials: A
authors.lastname: Salles
authors.affiliation: Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive Neurology (INECO), Favaloro University, Buenos Aires, Institute of Neuroscience, Favaloro University, Buenos Aires, Argentina, National Scientific and Technical Research Council (CONICET), Argentina, Laboratory of Cognitive and Social Neuroscience (LaNCyS), UDP-INECO Foundation Core on Neuroscience (UIFCoN), Diego Portales University, Santiago, Chile, Physics Department, Laboratory of Integrative Neuroscience, University of Buenos Aires, Department of Cardiology and Cardiosurgery, Favaloro University, Buenos Aires, Argentina, Institut National de la Santé et de la Recherche Médicale (INSERM), 91191 Gif sur Yvette, France, The Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK, and Universidad Torcuato Di Tella, Buenos Aires, Argentina Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive Neurology (INECO), Favaloro University, Buenos Aires, Institute of Neuroscience, Favaloro University, Buenos Aires, Argentina, National Scientific and Technical Research Council (CONICET), Argentina, Laboratory of Cognitive and Social Neuroscience (LaNCyS), UDP-INECO Foundation Core on Neuroscience (UIFCoN), Diego Portales University, Santiago, Chile, Physics Department, Laboratory of Integrative Neuroscience, University of Buenos Aires, Department of Cardiology and Cardiosurgery, Favaloro University, Buenos Aires, Argentina, Institut National de la Santé et de la Recherche Médicale (INSERM), 91191 Gif sur Yvette, France, The Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK, and Universidad Torcuato Di Tella, Buenos Aires, Argentina Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive Neurology (INECO), Favaloro University, Buenos Aires, Institute of Neuroscience, Favaloro University, Buenos Aires, Argentina, National Scientific and Technical Research Council (CONICET), Argentina, La
authors.forename: Lucas
authors.initials: L
authors.lastname: Sedeño
authors.affiliation: Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive Neurology (INECO), Favaloro University, Buenos Aires, Institute of Neuroscience, Favaloro University, Buenos Aires, Argentina, National Scientific and Technical Research Council (CONICET), Argentina, Laboratory of Cognitive and Social Neuroscience (LaNCyS), UDP-INECO Foundation Core on Neuroscience (UIFCoN), Diego Portales University, Santiago, Chile, Physics Department, Laboratory of Integrative Neuroscience, University of Buenos Aires, Department of Cardiology and Cardiosurgery, Favaloro University, Buenos Aires, Argentina, Institut National de la Santé et de la Recherche Médicale (INSERM), 91191 Gif sur Yvette, France, The Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK, and Universidad Torcuato Di Tella, Buenos Aires, Argentina.
authors.forename: Margarita
authors.initials: M
authors.lastname: Peradejordi
authors.affiliation: Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive Neurology (INECO), Favaloro University, Buenos Aires, Institute of Neuroscience, Favaloro University, Buenos Aires, Argentina, National Scientific and Technical Research Council (CONICET), Argentina, Laboratory of Cognitive and Social Neuroscience (LaNCyS), UDP-INECO Foundation Core on Neuroscience (UIFCoN), Diego Portales University, Santiago, Chile, Physics Department, Laboratory of Integrative Neuroscience, University of Buenos Aires, Department of Cardiology and Cardiosurgery, Favaloro University, Buenos Aires, Argentina, Institut National de la Santé et de la Recherche Médicale (INSERM), 91191 Gif sur Yvette, France, The Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK, and Universidad Torcuato Di Tella, Buenos Aires, Argentina Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive Neurology (INECO), Favaloro University, Buenos Aires, Institute of Neuroscience, Favaloro University, Buenos Aires, Argentina, National Scientific and Technical Research Council (CONICET), Argentina, Laboratory of Cognitive and Social Neuroscience (LaNCyS), UDP-INECO Foundation Core on Neuroscience (UIFCoN), Diego Portales University, Santiago, Chile, Physics Department, Laboratory of Integrative Neuroscience, University of Buenos Aires, Department of Cardiology and Cardiosurgery, Favaloro University, Buenos Aires, Argentina, Institut National de la Santé et de la Recherche Médicale (INSERM), 91191 Gif sur Yvette, France, The Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK, and Universidad Torcuato Di Tella, Buenos Aires, Argentina.
authors.forename: Pablo
authors.initials: P
authors.lastname: Barttfeld
authors.affiliation: Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive Neurology (INECO), Favaloro University, Buenos Aires, Institute of Neuroscience, Favaloro University, Buenos Aires, Argentina, National Scientific and Technical Research Council (CONICET), Argentina, Laboratory of Cognitive and Social Neuroscience (LaNCyS), UDP-INECO Foundation Core on Neuroscience (UIFCoN), Diego Portales University, Santiago, Chile, Physics Department, Laboratory of Integrative Neuroscience, University of Buenos Aires, Department of Cardiology and Cardiosurgery, Favaloro University, Buenos Aires, Argentina, Institut National de la Santé et de la Recherche Médicale (INSERM), 91191 Gif sur Yvette, France, The Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK, and Universidad Torcuato Di Tella, Buenos Aires, Argentina Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive Neurology (INECO), Favaloro University, Buenos Aires, Institute of Neuroscience, Favaloro University, Buenos Aires, Argentina, National Scientific and Technical Research Council (CONICET), Argentina, Laboratory of Cognitive and Social Neuroscience (LaNCyS), UDP-INECO Foundation Core on Neuroscience (UIFCoN), Diego Portales University, Santiago, Chile, Physics Department, Laboratory of Integrative Neuroscience, University of Buenos Aires, Department of Cardiology and Cardiosurgery, Favaloro University, Buenos Aires, Argentina, Institut National de la Santé et de la Recherche Médicale (INSERM), 91191 Gif sur Yvette, France, The Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK, and Universidad Torcuato Di Tella, Buenos Aires, Argentina.
authors.forename: Andrés
authors.initials: A
authors.lastname: Canales-Johnson
authors.affiliation: Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive Neurology (INECO), Favaloro University, Buenos Aires, Institute of Neuroscience, Favaloro University, Buenos Aires, Argentina, National Scientific and Technical Research Council (CONICET), Argentina, Laboratory of Cognitive and Social Neuroscience (LaNCyS), UDP-INECO Foundation Core on Neuroscience (UIFCoN), Diego Portales University, Santiago, Chile, Physics Department, Laboratory of Integrative Neuroscience, University of Buenos Aires, Department of Cardiology and Cardiosurgery, Favaloro University, Buenos Aires, Argentina, Institut National de la Santé et de la Recherche Médicale (INSERM), 91191 Gif sur Yvette, France, The Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK, and Universidad Torcuato Di Tella, Buenos Aires, Argentina.
authors.forename: Yamil Vidal
authors.initials: YV
authors.lastname: Dos Santos
authors.affiliation: Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive Neurology (INECO), Favaloro University, Buenos Aires, Institute of Neuroscience, Favaloro University, Buenos Aires, Argentina, National Scientific and Technical Research Council (CONICET), Argentina, Laboratory of Cognitive and Social Neuroscience (LaNCyS), UDP-INECO Foundation Core on Neuroscience (UIFCoN), Diego Portales University, Santiago, Chile, Physics Department, Laboratory of Integrative Neuroscience, University of Buenos Aires, Department of Cardiology and Cardiosurgery, Favaloro University, Buenos Aires, Argentina, Institut National de la Santé et de la Recherche Médicale (INSERM), 91191 Gif sur Yvette, France, The Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK, and Universidad Torcuato Di Tella, Buenos Aires, Argentina.
authors.forename: David
authors.initials: D
authors.lastname: Huepe
authors.affiliation: Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive Neurology (INECO), Favaloro University, Buenos Aires, Institute of Neuroscience, Favaloro University, Buenos Aires, Argentina, National Scientific and Technical Research Council (CONICET), Argentina, Laboratory of Cognitive and Social Neuroscience (LaNCyS), UDP-INECO Foundation Core on Neuroscience (UIFCoN), Diego Portales University, Santiago, Chile, Physics Department, Laboratory of Integrative Neuroscience, University of Buenos Aires, Department of Cardiology and Cardiosurgery, Favaloro University, Buenos Aires, Argentina, Institut National de la Santé et de la Recherche Médicale (INSERM), 91191 Gif sur Yvette, France, The Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK, and Universidad Torcuato Di Tella, Buenos Aires, Argentina.
authors.forename: Tristán
authors.initials: T
authors.lastname: Bekinschtein
authors.affiliation: Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive Neurology (INECO), Favaloro University, Buenos Aires, Institute of Neuroscience, Favaloro University, Buenos Aires, Argentina, National Scientific and Technical Research Council (CONICET), Argentina, Laboratory of Cognitive and Social Neuroscience (LaNCyS), UDP-INECO Foundation Core on Neuroscience (UIFCoN), Diego Portales University, Santiago, Chile, Physics Department, Laboratory of Integrative Neuroscience, University of Buenos Aires, Department of Cardiology and Cardiosurgery, Favaloro University, Buenos Aires, Argentina, Institut National de la Santé et de la Recherche Médicale (INSERM), 91191 Gif sur Yvette, France, The Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK, and Universidad Torcuato Di Tella, Buenos Aires, Argentina Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive Neurology (INECO), Favaloro University, Buenos Aires, Institute of Neuroscience, Favaloro University, Buenos Aires, Argentina, National Scientific and Technical Research Council (CONICET), Argentina, Laboratory of Cognitive and Social Neuroscience (LaNCyS), UDP-INECO Foundation Core on Neuroscience (UIFCoN), Diego Portales University, Santiago, Chile, Physics Department, Laboratory of Integrative Neuroscience, University of Buenos Aires, Department of Cardiology and Cardiosurgery, Favaloro University, Buenos Aires, Argentina, Institut National de la Santé et de la Recherche Médicale (INSERM), 91191 Gif sur Yvette, France, The Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK, and Universidad Torcuato Di Tella, Buenos Aires, Argentina Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive Neurology (INECO), Favaloro University, Buenos Aires, Institute of Neuroscience, Favaloro University, Buenos Aires, Argentina, National Scientific and Technical Research Council (CONICET), Argentina, La
authors.forename: Mariano
authors.initials: M
authors.lastname: Sigman
authors.affiliation: Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive Neurology (INECO), Favaloro University, Buenos Aires, Institute of Neuroscience, Favaloro University, Buenos Aires, Argentina, National Scientific and Technical Research Council (CONICET), Argentina, Laboratory of Cognitive and Social Neuroscience (LaNCyS), UDP-INECO Foundation Core on Neuroscience (UIFCoN), Diego Portales University, Santiago, Chile, Physics Department, Laboratory of Integrative Neuroscience, University of Buenos Aires, Department of Cardiology and Cardiosurgery, Favaloro University, Buenos Aires, Argentina, Institut National de la Santé et de la Recherche Médicale (INSERM), 91191 Gif sur Yvette, France, The Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK, and Universidad Torcuato Di Tella, Buenos Aires, Argentina.
authors.forename: Roberto
authors.initials: R
authors.lastname: Favaloro
authors.affiliation: Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive Neurology (INECO), Favaloro University, Buenos Aires, Institute of Neuroscience, Favaloro University, Buenos Aires, Argentina, National Scientific and Technical Research Council (CONICET), Argentina, Laboratory of Cognitive and Social Neuroscience (LaNCyS), UDP-INECO Foundation Core on Neuroscience (UIFCoN), Diego Portales University, Santiago, Chile, Physics Department, Laboratory of Integrative Neuroscience, University of Buenos Aires, Department of Cardiology and Cardiosurgery, Favaloro University, Buenos Aires, Argentina, Institut National de la Santé et de la Recherche Médicale (INSERM), 91191 Gif sur Yvette, France, The Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK, and Universidad Torcuato Di Tella, Buenos Aires, Argentina Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive Neurology (INECO), Favaloro University, Buenos Aires, Institute of Neuroscience, Favaloro University, Buenos Aires, Argentina, National Scientific and Technical Research Council (CONICET), Argentina, Laboratory of Cognitive and Social Neuroscience (LaNCyS), UDP-INECO Foundation Core on Neuroscience (UIFCoN), Diego Portales University, Santiago, Chile, Physics Department, Laboratory of Integrative Neuroscience, University of Buenos Aires, Department of Cardiology and Cardiosurgery, Favaloro University, Buenos Aires, Argentina, Institut National de la Santé et de la Recherche Médicale (INSERM), 91191 Gif sur Yvette, France, The Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK, and Universidad Torcuato Di Tella, Buenos Aires, Argentina.
authors.forename: Facundo
authors.initials: F
authors.lastname: Manes
authors.affiliation: Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive Neurology (INECO), Favaloro University, Buenos Aires, Institute of Neuroscience, Favaloro University, Buenos Aires, Argentina, National Scientific and Technical Research Council (CONICET), Argentina, Laboratory of Cognitive and Social Neuroscience (LaNCyS), UDP-INECO Foundation Core on Neuroscience (UIFCoN), Diego Portales University, Santiago, Chile, Physics Department, Laboratory of Integrative Neuroscience, University of Buenos Aires, Department of Cardiology and Cardiosurgery, Favaloro University, Buenos Aires, Argentina, Institut National de la Santé et de la Recherche Médicale (INSERM), 91191 Gif sur Yvette, France, The Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK, and Universidad Torcuato Di Tella, Buenos Aires, Argentina Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive Neurology (INECO), Favaloro University, Buenos Aires, Institute of Neuroscience, Favaloro University, Buenos Aires, Argentina, National Scientific and Technical Research Council (CONICET), Argentina, Laboratory of Cognitive and Social Neuroscience (LaNCyS), UDP-INECO Foundation Core on Neuroscience (UIFCoN), Diego Portales University, Santiago, Chile, Physics Department, Laboratory of Integrative Neuroscience, University of Buenos Aires, Department of Cardiology and Cardiosurgery, Favaloro University, Buenos Aires, Argentina, Institut National de la Santé et de la Recherche Médicale (INSERM), 91191 Gif sur Yvette, France, The Medical Research Council Cognition and Brain Sciences Unit, Cambridge, UK, and Universidad Torcuato Di Tella, Buenos Aires, Argentina Laboratory of Experimental Psychology and Neuroscience (LPEN), Institute of Cognitive Neurology (INECO), Favaloro University, Buenos Aires, Institute of Neuroscience, Favaloro University, Buenos Aires, Argentina, National Scientific and Technical Research Council (CONICET), Argentina, La
authors.forename: Agustin
authors.initials: A
authors.lastname: Ibanez
mesh_terms: D000328:Adult; D000344:Afferent Pathways / Q000502:physiology*; D002540:Cerebral Cortex / Q000502:physiology*; D003072:Cognition Disorders / Q000175:diagnosis / Q000209:etiology; D004562:Electrocardiography; D004569:Electroencephalography; D004644:Emotions / Q000502:physiology*; D005260:Female; D006333:Heart Failure / Q000150:complications* / Q000523:psychology* / Q000601:surgery; D006339:Heart Rate / Q000502:physiology; D006353:Heart-Assist Devices / Q000523:psychology*; D006801:Humans; D065812:Interoception; D008297:Male; D009483:Neuropsychological Tests; D055815:Young Adult
keywords: HEP; heart-brain; insula; interoception; social cognition